Healthcare Provider Details

I. General information

NPI: 1750955191
Provider Name (Legal Business Name): ACUPUNCTURE AND PHYSICAL THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 W 7TH ST STE 210
FORT WORTH TX
76107-2223
US

IV. Provider business mailing address

470 W HARWOOD RD
HURST TX
76054-2939
US

V. Phone/Fax

Practice location:
  • Phone: 817-498-8449
  • Fax: 817-281-4829
Mailing address:
  • Phone: 817-498-8449
  • Fax: 817-281-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA SEXTON
Title or Position: CREDENTIALING/INS COOR
Credential: LMT
Phone: 817-498-8449