MEDICARE: METROPLEX INTEGRATIVE REHABILITATION SERVICES

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	101Y00000X	Counselor	69237	TX
2	208VP0000X	Pain Medicine Physician	J6589	TX
3	225100000X	Physical Therapist	1068195	TX
4	363LX0106X	Occupational Health Nurse Practitioner	AP133741	TX
5	111N00000X	Chiropractor		TX

General Provider Information

NPI Number	:	1275068314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX INTEGRATIVE REHABILITATION SERVICES

Provider Business Mailing Address
First Line	:	5703 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3301
Country	:	US
Telephone Number	:	817-921-3000
Fax Number	:	817-921-3001

Provider Business Practice Location Address
First Line	:	5703 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3301
Country	:	US
Telephone Number	:	817-921-3000
Fax Number	:	817-921-3001

Authorized Official
Title or Position	:	CHIEF ADMINISTRATION OFFICER
Name	:	TERESA MARTIN
Credential	:
Telephone Number	:	817-921-3000

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/26/2017

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