MEDICARE: COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP

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

General Provider Information

NPI Number	:	1386989069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	1300 W SAM HOUSTON PKWY S
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77042-2447
Country	:	US
Telephone Number	:	713-297-7000
Fax Number	:	713-297-6381

Provider Business Practice Location Address
First Line	:	4364 HERITAGE TRACE PKWY
Second Line	:	SUITE 108
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9106
Country	:	US
Telephone Number	:	817-379-1400
Fax Number	:	817-379-1404

Authorized Official
Title or Position	:	VP, AUTHORIZED OFFICIAL
Name	:	RICHARD BINSTEIN
Credential	:
Telephone Number	:	713-297-7000

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	04/16/2024

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