Basic Information
| Provider Information | |||||||||
| NPI: | 1699980250 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PHYSICAL THERAPY OF NORTH TEXAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 413 W BETHEL RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750194473 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2445 W OAK ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762014325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403206030 | ||||||||
| FaxNumber: | 9403203113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CORRIGAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.