Healthcare Provider Details

I. General information

NPI: 1124780036
Provider Name (Legal Business Name): ZOLL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 TEAROSE TRL
FORT WORTH TX
76123-1817
US

IV. Provider business mailing address

4716 TEAROSE TRL
FORT WORTH TX
76123-1817
US

V. Phone/Fax

Practice location:
  • Phone: 817-880-5701
  • Fax:
Mailing address:
  • Phone: 817-880-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER JANE ZOLL
Title or Position: CLINICAL DIRECTOR
Credential: PT, CBIS, MSPT
Phone: 817-880-5701