Organization
CORE PHYSICAL THERAPY KELLER
Active
Organization
CORE PHYSICAL THERAPY KELLER
Active
Parent organization
CASTLE SURGICAL MANAGEMENT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CASTLE SURGICAL MANAGEMENT LLC
Authorized official
NICOLE TATE (CREDENTIALING)
(817) 200-6492
Entity
Organization
Contact information
Practice address
601 S MAIN ST STE 105, KELLER, TX 76248-7027
(501) 580-8352
Mailing address
901 W BARDIN RD STE 100, ARLINGTON, TX 76017-6000
(817) 200-6492
(817) 549-8116
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Enumeration date
03/25/2022
Last updated
03/25/2022
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