Basic Information
| Provider Information | |||||||||
| NPI: | 1770123481 | ||||||||
| 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: | 750198607 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12520 WILLOW SPRINGS ROAD | ||||||||
| Address2: | BUILDING 3, SUITE 104 | ||||||||
| City: | HASLET | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172106196 | ||||||||
| FaxNumber: | 8177829303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2020 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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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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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.