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Organization
SOUTHLAKE SPORTS & SPINE REHAB PLLC
Active
Organization
SOUTHLAKE SPORTS & SPINE REHAB PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL DEAN JUDD PT, MPT, OCS (OWNER)
(817) 498-3919
Entity
Organization
Contact information
Practice address
1050 E HIGHWAY 114, SUITE 110, SOUTHLAKE, TX 76092-5253
(817) 491-4775
Mailing address
1109 CHURCH ST, COLLEYVILLE, TX 76034-5849
(817) 498-3919
(817) 498-7080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
05/19/2011
Last updated
05/19/2011
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