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1932291697

NPI Code Detail

MEDICARE: STEPHENVILLE SPORTS REHAB & PHYSICAL THERAPY, LLC

MEDICARE: STEPHENVILLE SPORTS REHAB & PHYSICAL THERAPY, 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	208100000X	Physical Medicine & Rehabilitation Physician
2	208100000X	Physical Medicine & Rehabilitation Physician	651220000	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	278208	OTHER		SCOTT & WHITE HEALTH PLAN
2	622548400	OTHER	TX	DEPT OF LOABOR
3	0040JB	OTHER	TX	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	9767023	OTHER		CIGNA

General Provider Information

NPI Number	:	1932291697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHENVILLE SPORTS REHAB & PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	141 COLLEGE PARK DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5653
Country	:	US
Telephone Number	:	817-341-3600
Fax Number	:	817-599-8181

Provider Business Practice Location Address
First Line	:	141 COLLEGE PARK DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-5653
Country	:	US
Telephone Number	:	817-341-3600
Fax Number	:	817-599-8181

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CHAD ALLEN ELMS
Credential	:	PT
Telephone Number	:	817-341-3600

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	11/08/2024

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Directions to “STEPHENVILLE SPORTS REHAB & PHYSICAL THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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