MEDICARE: TRINITY THERAPEUTIC RESOURCES

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
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1366999286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY THERAPEUTIC RESOURCES

Provider Business Mailing Address
First Line	:	835 SW ALSBURY BLVD UNIT K
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-4094
Country	:	US
Telephone Number	:	817-937-1522
Fax Number	:	817-357-4046

Provider Business Practice Location Address
First Line	:	835 SW ALSBURY BLVD UNIT K
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-4094
Country	:	US
Telephone Number	:	817-937-1522
Fax Number	:	817-357-4046

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LESA HOUGH
Credential	:	OTR
Telephone Number	:	817-937-1522

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	08/11/2017

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