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General NPI Number Information
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NPI Number | 1821149733
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Entity Type | Organization
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Legal Business Name | FORT WORTH REHAB GROUP
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3301 N MAIN ST SUITE B
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City | FORT WORTH
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State | TX
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Zip | 76106-4344
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Country | US
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Telephone | 817-624-4141
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Fax | 817-624-4227
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Provider Business Mailing Address
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Address Line | 3523 MCKINNEY AVE # 246
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City | DALLAS
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State | TX
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Zip | 75204-1401
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Country | US
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Telephone | 214-432-0910
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. BRANDI O'BANION
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Credential |
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Telephone | 214-432-0910
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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 | 8454
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License Number State | TX
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