Healthcare Provider Details

I. General information

NPI: 1386157394
Provider Name (Legal Business Name): NEUROLOGICAL RECOVERY FOR THE ARMED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6913 CAMP BOWIE BLVD STE 177
FORT WORTH TX
76116-7169
US

IV. Provider business mailing address

6913 CAMP BOWIE BLVD STE 177
FORT WORTH TX
76116-7169
US

V. Phone/Fax

Practice location:
  • Phone: 317-496-6276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: COURTNEY KEATHLEY
Title or Position: BILLING MANAGER
Credential:
Phone: 682-312-7693