MEDICARE: ALL PRO THERAPY KELLER

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

General Provider Information

NPI Number	:	1356091045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL PRO THERAPY KELLER

Provider Business Mailing Address
First Line	:	901 W BARDIN RD STE 100
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-6000
Country	:	US
Telephone Number	:	817-200-6492
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 HERITAGE TRACE PKWY STE 404
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8944
Country	:	US
Telephone Number	:	501-580-8352
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	NICOLE TATE
Credential	:
Telephone Number	:	817-200-6492

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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