Healthcare Provider Details

I. General information

NPI: 1649561796
Provider Name (Legal Business Name): GWENDOLYN MARI CHAPMAN PT, MOMT, CKTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CROWN POINTE BLVD
WILLOW PARK TX
76087-1191
US

IV. Provider business mailing address

101 CROWN POINTE BLVD
WILLOW PARK TX
76087-1191
US

V. Phone/Fax

Practice location:
  • Phone: 817-757-1580
  • Fax: 817-757-1590
Mailing address:
  • Phone: 817-757-1580
  • Fax: 817-757-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1068567
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: