Organization
PT2 SPORTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DALE W SMITH PT, OCS (PRESIDENT/OWNER)
(214) 695-8847
Entity
Organization
Contact information
Practice address
1602 HART ST, SOUTHLAKE, TX 76092
(214) 695-8847
(214) 239-0991
Mailing address
PO BOX 670846, DALLAS, TX 75367-0846
(214) 695-8847
(214) 239-0991
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
666340000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
823T99
BLUE CROSS BLUE SHIELD OF TEXAS
TX
Enumeration date
07/22/2009
Last updated
03/24/2017
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