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General NPI Number Information
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NPI Number | 1801506191
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Entity Type | Organization
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Legal Business Name | BIG HEART CENTER FOR BRAIN CHANGE
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 5209 CHATSWORTH LN
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City | FORT WORTH
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State | TX
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Zip | 76244-5018
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Country | US
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Telephone | 817-201-9656
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Fax |
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Provider Business Mailing Address
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Address Line | 5209 CHATSWORTH LN
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City | FORT WORTH
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State | TX
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Zip | 76244-5018
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Country | US
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Telephone |
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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 | DR. ALISON GEYMER
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Credential | PT
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Telephone | 817-201-9656
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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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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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