Healthcare Provider Details

I. General information

NPI: 1932317583
Provider Name (Legal Business Name): VARSITY ORTHOPEDICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9545 N BEACH ST STE 133
FORT WORTH TX
76244-6471
US

IV. Provider business mailing address

501 W HARWOOD RD
HURST TX
76054-3163
US

V. Phone/Fax

Practice location:
  • Phone: 817-431-1017
  • Fax: 817-431-1032
Mailing address:
  • Phone: 817-268-2758
  • Fax: 817-268-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberH8341
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberH8341
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberH8341
License Number StateTX

VIII. Authorized Official

Name: DR. CHRISTINE QUATRO OTT
Title or Position: DOCTOR OF OSTEOPATHY
Credential: D.O.
Phone: 817-431-1017