Organization
PHYSICAL THERAPY OF MANSFIELD,LLC
Active
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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