Basic Information
| Provider Information | |||||||||
| NPI: | 1548672132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2650 | ||||||||
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| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198650 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2817 S MAYHILL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762085966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723049100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2014 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP,AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.