Healthcare Provider Details

I. General information

NPI: 1508534611
Provider Name (Legal Business Name): CK PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 LACKLAND RD STE 101
FORT WORTH TX
76116-4173
US

IV. Provider business mailing address

141 CRIMSON SKY CT
ALEDO TX
76008-1316
US

V. Phone/Fax

Practice location:
  • Phone: 210-216-6367
  • Fax: 469-532-0204
Mailing address:
  • Phone: 210-216-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER A KOTTWITZ
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 210-216-6367