MEDICARE: PEARL ENGLISH PTA

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	2121847	TX

General Provider Information

NPI Number	:	1962210120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL ENGLISH PTA

Provider Business Mailing Address
First Line	:	13233 FIELDSTONE RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5744
Country	:	US
Telephone Number	:	682-219-7314
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 AMADOR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2227
Country	:	US
Telephone Number	:	817-438-1922
Fax Number	:

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

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	12/20/2024

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Directions to “ PEARL ENGLISH PTA” Practice Location

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