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General NPI Number Information
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NPI Number | 1952117251
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Entity Type | Organization
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Legal Business Name | ALL PRO REHABILITATION & PRIMARY CARE PLLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 4444 HERITAGE TRACE PKWY STE 404
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City | FORT WORTH
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State | TX
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Zip | 76244-8944
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Country | US
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Telephone | 817-741-2776
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Fax | 817-442-8637
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Provider Business Mailing Address
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Address Line | 1940 E STATE HIGHWAY 114 STE 150
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6526
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Country | US
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Telephone | 817-424-3668
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Fax | 817-442-8637
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Authorized Official
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Title or Position | PARTNER
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Name | PAUL MARCIANO
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Credential | DPM
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Telephone | 817-308-6613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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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 | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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