Healthcare Provider Details

I. General information

NPI: 1780911123
Provider Name (Legal Business Name): COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 STATE HIGHWAY 114 EAST SUITE 120
TROPHY CLUB TX
76262
US

IV. Provider business mailing address

PO BOX 2650
COPPELL TX
75019-8650
US

V. Phone/Fax

Practice location:
  • Phone: 817-491-3403
  • Fax: 817-491-3308
Mailing address:
  • Phone:
  • 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: RICHARD BINSTEIN
Title or Position: VP, AUTHORIZED OFFICIAL
Credential: JD
Phone: 713-297-7052