Organization
TMI SPORTS THERAPY LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES WABBERSEN P.T. (THERAPIST)
(972) 623-2629
Entity
Organization
Contact information
Practice address
2044 N HWY 360, GRAND PRAIRIE, TX 75050-1423
(972) 623-2629
(972) 623-2661
Mailing address
2044 N HWY 360, GRAND PRAIRIE, TX 75050-1423
(972) 623-2629
(972) 623-2661
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1157230
TX
2255A2300X
Athletic Trainer
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0041PB
BCBS-GROUP#
TX
01
—
8T6887
BCBS-INDIVIDUAL #
TX
Enumeration date
09/27/2007
Last updated
10/27/2007
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