Healthcare Provider Details

I. General information

NPI: 1972959948
Provider Name (Legal Business Name): TED VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W ROYAL LN SUITE 196
IRVING TX
75063-1996
US

IV. Provider business mailing address

5005 W ROYAL LN SUITE 196
IRVING TX
75063-1996
US

V. Phone/Fax

Practice location:
  • Phone: 817-485-5100
  • Fax:
Mailing address:
  • Phone: 817-485-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES NEFF
Title or Position: DIRECTOR
Credential:
Phone: 817-485-5100