MEDICARE: KASS

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
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	454812	TX

General Provider Information

NPI Number	:	1114382975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KASS

Provider Business Mailing Address
First Line	:	2817 STARK STREET
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112
Country	:	US
Telephone Number	:	817-451-6413
Fax Number	:	817-451-7712

Provider Business Practice Location Address
First Line	:	2817 STARK ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6562
Country	:	US
Telephone Number	:	817-451-6413
Fax Number	:	817-451-7712

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHELLEY STRAWTHER
Credential	:
Telephone Number	:	817-451-6413

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/22/2015

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Directions to “KASS ” Practice Location

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