Organization
JAP PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUGUSTINE NUBEA FOMBON DPT (OWNER)
(214) 718-9593
Entity
Organization
Contact information
Practice address
601 S GREAT SOUTHWEST PKWY STE 106, GRAND PRAIRIE, TX 75051-1057
(214) 419-2528
Mailing address
601 S GREAT SOUTHWEST PKWY STE 106, GRAND PRAIRIE, TX 75051-1057
(214) 419-2528
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE YET
TX
Enumeration date
09/18/2019
Last updated
09/18/2019
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