# HEALTHTEXAS PROVIDER NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Physiatric Medicine Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841225919
- **Authorized official:** MRS. ELLEN ELIZABETH FOURTON (DIRECTOR)
- **Authorized official phone:** (972) 860-8649

## Contact information

- **Practice address:** 1643 LANCASTER DR, SUITE 101A, GRAPEVINE, TX 76051-3593
- **Practice address phone:** (817) 424-4151
- **Practice address fax:** (817) 424-4181
- **Mailing address:** 8080 N CENTRAL EXPY, SUITE 1650, DALLAS, TX 75206-1838
- **Mailing address phone:** (972) 860-8648
- **Mailing address fax:** (972) 860-8679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 03/07/2008