# SPORTHERAPY SOUTHWEST, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801812698
- **Authorized official:** MR. STEVEN B LACKEY (BUSINESS DIRECTOR)
- **Authorized official phone:** (817) 370-9891

## Contact information

- **Practice address:** 6037 HARRIS PKWY, FORT WORTH, TX 76132-4103
- **Practice address phone:** (817) 370-9891
- **Practice address fax:** (817) 370-9894
- **Mailing address:** 6037 HARRIS PKWY, FORT WORTH, TX 76132-4103
- **Mailing address phone:** (817) 370-9891
- **Mailing address fax:** (817) 370-9894

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 605100000 | TX | — |
| 261QR0400X | Rehabilitation Clinic/Center | 605100000 | TX | — |
| 261QR0401X | Comprehensive Outpatient Rehabilitation Facility (CORF) | 605100000 | TX | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 05/20/2014