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NPI Code Detail

MEDICARE: PHYSICAL MANAGEMENT PROFESSIONALS LLC

MEDICARE: PHYSICAL MANAGEMENT PROFESSIONALS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1096931TX

General Provider Information

NPI Number : 1063709475
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICAL MANAGEMENT PROFESSIONALS LLC
Provider Business Mailing Address
First Line : 2550 BOYD AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1021
Country : US
Telephone Number : 817-480-3798
Fax Number : 866-630-5649
Provider Business Practice Location Address
First Line : 2550 BOYD AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1021
Country : US
Telephone Number : 817-480-3798
Fax Number : 866-630-5649
Authorized Official
Title or Position : OWNER
Name : SHAY SMITH
Credential : PT
Telephone Number : 817-480-3798
Provider Enumeration Date : 07/06/2011
Last Update Date : 07/06/2011

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Directions to “PHYSICAL MANAGEMENT PROFESSIONALS LLC ” Practice Location

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