Healthcare Provider Details

I. General information

NPI: 1821530775
Provider Name (Legal Business Name): VELOCITY PHYSICAL THERAPY-CROSS ROADS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 US HWY 380 SUITE 100
CROSS ROADS TX
76227
US

IV. Provider business mailing address

8800 US HWY 380 SUITE 100
CROSS ROADS TX
76227
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1228012
License Number StateTX

VIII. Authorized Official

Name: DOUG SOELL
Title or Position: OWNER
Credential:
Phone: 940-387-3700