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General NPI Number Information
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NPI Number | 1114382975
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Entity Type | Organization
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Legal Business Name | KASS
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 2817 STARK ST
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City | FORT WORTH
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State | TX
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Zip | 76112-6562
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Country | US
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Telephone | 817-451-6413
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Fax | 817-451-7712
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Provider Business Mailing Address
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Address Line | 2817 STARK STREET
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City | FORT WORTH
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State | TX
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Zip | 76112
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Country | US
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Telephone | 817-451-6413
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Fax | 817-451-7712
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHELLEY STRAWTHER
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Credential |
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Telephone | 817-451-6413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 454812
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License Number State | TX
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