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Organization
GLEN ROSE PHYSICAL THERAPY AND SPORTS REHAB, P.C.
Active
Organization
GLEN ROSE PHYSICAL THERAPY AND SPORTS REHAB, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK KEVIN COLE LPT (OWNER OPERATOR)
(254) 898-2121
Entity
Organization
Contact information
Practice address
1005 NE BIG BEND TRL, SUITE 3, GLEN ROSE, TX 76043-4942
(254) 898-2121
(254) 898-1616
Mailing address
PO BOX 292, GLEN ROSE, TX 76043-0292
(254) 898-2121
(254) 898-1616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1078459
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015NN
BCBS
TX
05
—
181331301
—
TX
Enumeration date
01/09/2007
Last updated
07/24/2007
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