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General NPI Number Information
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NPI Number | 1881988780
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Entity Type | Organization
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Legal Business Name | RETURN2SPORTS PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 2835 EXCHANGE BLVD SUITE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9192
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Country | US
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Telephone | 817-891-6048
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Fax | 817-431-8264
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Provider Business Mailing Address
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Address Line | 2835 EXCHANGE BLVD SUITE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9192
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Country | US
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Telephone | 817-891-6048
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Fax | 817-431-8264
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. GRETA LEIGH MCGAUGH
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Credential |
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Telephone | 817-891-6048
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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 | 1161126
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License Number State | TX
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