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General NPI Number Information
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NPI Number | 1215630603
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Entity Type | Organization
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Legal Business Name | MAHOGANY PELVIC HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 02/25/2024
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Provider Practice Location Address
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Address Line | 800 PARKER SQ STE 210
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City | FLOWER MOUND
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State | TX
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Zip | 75028-7434
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Country | US
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Telephone | 817-492-6500
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Fax | 469-521-9919
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Provider Business Mailing Address
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Address Line | 2900 MAPLE CREEK DR
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City | FORT WORTH
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State | TX
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Zip | 76177-2125
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Country | US
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Telephone | 817-917-1331
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | GLORIA JANAE STEPHENS
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Credential | PT
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Telephone | 817-917-1331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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