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General NPI Number Information
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NPI Number | 1194776872
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Entity Type | Organization
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Legal Business Name | METROPLEX MEDICAL REHABILITATION & SPORTS MEDICINE PA
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 6116 OAKBEND TRL SUITE 112
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City | FORT WORTH
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State | TX
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Zip | 76132-3925
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Country | US
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Telephone | 817-423-9054
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Fax | 817-423-9719
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Provider Business Mailing Address
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Address Line | PO BOX 678596
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City | DALLAS
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State | TX
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Zip | 75267-8595
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Country | US
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Telephone | 817-423-9054
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Fax | 817-423-9719
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELIZABETH J LEE
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Credential | DO
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Telephone | 817-284-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | K5755
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License Number State | TX
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