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Organization
SOURCE ONE REHABILITATION
Active
Organization
SOURCE ONE REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARROD ROGERS (PRES/CEO)
(214) 577-9191
Entity
Organization
Contact information
Practice address
5425 W SPRING CREEK PKWY STE 270, PLANO, TX 75024-4317
(972) 801-2190
(972) 801-2191
Mailing address
PO BOX 251728, PLANO, TX 75025-1517
(972) 801-2190
(972) 801-2191
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
Other
Enumeration date
10/20/2011
Last updated
03/24/2022
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