Healthcare Provider Details

I. General information

NPI: 1750971669
Provider Name (Legal Business Name): WOUNDCARE PARTNERS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN STE C239
DALLAS TX
75230-7522
US

IV. Provider business mailing address

2637 N WASHINGTON BLVD # 164
NORTH OGDEN UT
84414-2240
US

V. Phone/Fax

Practice location:
  • Phone: 214-970-6817
  • Fax: 844-803-4513
Mailing address:
  • Phone: 214-970-6817
  • Fax: 844-803-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN VAWTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-970-6817