MEDICARE: METROPLEX MEDICAL REHABILITATION & SPORTS MEDICINE PA

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	208100000X	Physical Medicine & Rehabilitation Physician	K5755	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0033DV	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0030PX	OTHER		BCBS
4	0033DV	OTHER	TX	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1194776872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX MEDICAL REHABILITATION & SPORTS MEDICINE PA

Provider Business Mailing Address
First Line	:	PO BOX 678596
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-8595
Country	:	US
Telephone Number	:	817-423-9054
Fax Number	:	817-423-9719

Provider Business Practice Location Address
First Line	:	6116 OAKBEND TRL
Second Line	:	SUITE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-423-9054
Fax Number	:	817-423-9719

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ELIZABETH J LEE
Credential	:	DO
Telephone Number	:	817-284-9850

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/28/2012

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Directions to “METROPLEX MEDICAL REHABILITATION & SPORTS MEDICINE PA ” Practice Location

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