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General NPI Number Information
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NPI Number | 1003929357
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Entity Type | Organization
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Legal Business Name | SPORTS REHABILITATION SPECIALISTS, INC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 1901 COOPER ST
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City | FT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-877-8977
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Fax | 817-877-1106
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Provider Business Mailing Address
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Address Line | 1901 COOPER ST
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City | FT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-877-8977
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Fax | 817-877-1106
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SHEILA MARIE PICKREL
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Credential | PT
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Telephone | 817-877-8977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5292500
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License Number State | TX
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