MEDICARE: SPORTS THERAPY AND ADVANCED REHABILITATION, INC.

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	261QP2000X	Physical Therapy Clinic/Center	651590000	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0059J	OTHER	TX	BCBS ID

General Provider Information

NPI Number	:	1265441075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS THERAPY AND ADVANCED REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	7401 W HIGHWAY 71 STE 130
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-8260
Country	:	US
Telephone Number	:	512-288-2700
Fax Number	:	512-288-2711

Provider Business Practice Location Address
First Line	:	7401 W HIGHWAY 71 STE 130
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78735-8260
Country	:	US
Telephone Number	:	512-288-2700
Fax Number	:	512-288-2711

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MILISSA R BERRY
Credential	:
Telephone Number	:	512-288-2700

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/22/2014

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