MEDICARE: PREMIER REHAB PHYSICAL THERAPY AND AQUATICS

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	2251X0800X	Orthopedic Physical Therapist	1264458	TX

General Provider Information

NPI Number	:	1457728230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER REHAB PHYSICAL THERAPY AND AQUATICS

Provider Business Mailing Address
First Line	:	5060 DAVIS BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7004
Country	:	US
Telephone Number	:	817-498-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 WESTERN CENTER BLVD
Second Line	:	SUITE 312
City	:	FORT WORTH
State	:	TX
Zip	:	76131-4302
Country	:	US
Telephone Number	:	817-847-0200
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	KELLY MCFARLAND
Credential	:	PT, DPT
Telephone Number	:	817-498-8585

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	08/27/2015

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