Organization
COLLEYVILLE PHYSICAL THERAPY AND SPORTS REHAB, PC
Active
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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