Organization
COLLEYVILLE PHYSICAL THERAPY AND SPORTS REHAB, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL DEAN JUDD P.T. (OWNER)
(817) 498-3919
Entity
Organization
Contact information
Practice address
1109 CHURCH STREET, COLLEYVILLE, TX 76034-5489
(817) 498-3919
(817) 498-7080
Mailing address
1109 CHURCH ST, COLLEYVILLE, TX 76034-5849
(817) 498-3919
(817) 498-7080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097EX
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/01/2006
Last updated
06/10/2013
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