MEDICARE: TEXAS HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	103T00000X	Psychologist
3	111N00000X	Chiropractor
4	207Q00000X	Family Medicine Physician
5	225100000X	Physical Therapist
6	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1942749478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS HEALTH, LLC

Provider Business Mailing Address
First Line	:	3304 SE LOOP 820
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1113
Country	:	US
Telephone Number	:	817-984-7545
Fax Number	:	817-533-2654

Provider Business Practice Location Address
First Line	:	3304 SE LOOP 820
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1113
Country	:	US
Telephone Number	:	817-984-7545
Fax Number	:	817-533-2654

Authorized Official
Title or Position	:	MANAGER
Name	:	PHIL BOHART
Credential	:
Telephone Number	:	214-692-6666

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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Directions to “TEXAS HEALTH, LLC ” Practice Location

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