Organization
SUPPLEMENTAL HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MARTIN (PTA)
(806) 236-1553
Entity
Organization
Contact information
Practice address
5601 BRIDGE ST, SUITE 490, FORT WORTH, TX 76112-2384
(877) 441-7800
(877) 441-7802
Mailing address
6628 RICHARDSON DR, WATAUGA, TX 76148-2335
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
Primary
—
—
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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