Organization
PHYSICAL THERAPY OF MANSFIELD,LLC
Active
Other names
SUSAN G. ROBERSON
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ALAN ROBERSON (MANAGER)
(817) 473-4684
Entity
Organization
Contact information
Practice address
1580 HIGHWAY 287 N, 1580 HWY 287 N, MANSFIELD, TX 76063-7593
(817) 473-4684
(817) 473-1170
Mailing address
PO BOX 501, 1580 HWY 287 N, MANSFIELD, TX 76063-0501
(817) 473-4684
(817) 473-1170
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
658850000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135244
PT LICENSE
TX
01
—
604770000
CLINIC REGISTRATION
TX
01
—
612949000
OWCP FED#
TX
01
—
658850000
LICENSE
TX
01
—
752472481
OLD TAX ID
TX
01
—
DG4667
RAILROAD MEDICARE
TX
Enumeration date
08/11/2005
Last updated
11/20/2014
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