MEDICARE: RICHARD BRYAN GENZEL P.T.

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	1115566	TX

General Provider Information

NPI Number	:	1740404243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD BRYAN GENZEL P.T.

Provider Business Mailing Address
First Line	:	2420 E RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-6335
Country	:	US
Telephone Number	:	817-394-1010
Fax Number	:	917-394-1017

Provider Business Practice Location Address
First Line	:	2420 E RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-6335
Country	:	US
Telephone Number	:	817-394-1010
Fax Number	:	917-394-1017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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