Organization
SPORTHERAPY SOUTHWEST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN B LACKEY (BUSINESS DIRECTOR)
(817) 370-9891
Entity
Organization
Contact information
Practice address
6037 HARRIS PKWY, FORT WORTH, TX 76132-4103
(817) 370-9891
(817) 370-9894
Mailing address
6037 HARRIS PKWY, FORT WORTH, TX 76132-4103
(817) 370-9891
(817) 370-9894
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
605100000
TX
261QR0400X
Rehabilitation Clinic/Center
605100000
TX
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
605100000
TX
Other
Enumeration date
07/14/2006
Last updated
05/20/2014
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