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General NPI Number Information
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NPI Number | 1124020979
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY OF MANSFIELD,LLC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 1580 HIGHWAY 287 N 1580 HWY 287 N
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City | MANSFIELD
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State | TX
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Zip | 76063-7593
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Country | US
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Telephone | 817-473-4684
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Fax | 817-473-1170
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Provider Business Mailing Address
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Address Line | PO BOX 501 1580 HWY 287 N
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City | MANSFIELD
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State | TX
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Zip | 76063-0501
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Country | US
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Telephone | 817-473-4684
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Fax | 817-473-1170
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Authorized Official
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Title or Position | MANAGER
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Name | MR. DAVID ALAN ROBERSON
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Credential |
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Telephone | 817-473-4684
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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 | 658850000
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License Number State | TX
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