Healthcare Provider Details

I. General information

NPI: 1154797512
Provider Name (Legal Business Name): SNATCHED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9336 TEAM RANCH RD 101A
FORT WORTH TX
76126-2016
US

IV. Provider business mailing address

9336 TEAM RANCH RD 101A
FORT WORTH TX
76126-2016
US

V. Phone/Fax

Practice location:
  • Phone: 682-777-4572
  • Fax:
Mailing address:
  • Phone: 682-777-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number18004653203
License Number StateTX

VIII. Authorized Official

Name: HANNAH BURLESON
Title or Position: OWNER
Credential:
Phone: 214-450-5201