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General NPI Number Information
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NPI Number | 1568836732
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Entity Type | Organization
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Legal Business Name | MEDICAL EXERCISE THERAPY
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | 212 NE WILSHIRE BLVD
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City | BURLESON
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State | TX
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Zip | 76028-4117
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Country | US
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Telephone | 409-383-9521
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Fax | 817-642-5815
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Provider Business Mailing Address
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Address Line | 212 NE WILSHIRE BLVD
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City | BURLESON
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State | TX
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Zip | 76028-4117
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Country | US
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Telephone | 409-383-9521
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Fax | 817-642-5815
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Authorized Official
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Title or Position | OWNER
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Name | NATHAN NEAL WILLIAMS
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Credential | OWNER
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Telephone | 409-383-9521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | TX
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