MEDICARE: SPORTHERAPY LLC

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	225100000X	Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1386132132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTHERAPY LLC

Provider Business Mailing Address
First Line	:	6501 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6102
Country	:	US
Telephone Number	:	817-370-9891
Fax Number	:	817-370-9894

Provider Business Practice Location Address
First Line	:	6501 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6102
Country	:	US
Telephone Number	:	817-370-9891
Fax Number	:	817-370-9894

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DAVID BROWDER
Credential	:
Telephone Number	:	817-370-9891

Provider Enumeration Date	:	04/27/2018
Last Update Date	:	11/22/2024

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Directions to “SPORTHERAPY LLC ” Practice Location

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