Organization Name: | SOUTHLAKE SPORTS & SPINE REHAB PLLC |
NPI Number: | 1497048730 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOEL DEAN JUDD (OWNER) |
Mailing Address: | 1050 E Highway 114 Suite 110 Southlake |
State: | TX US |
Postal Code: | 760925253 |
Phone Number: | 8174914775 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2011 |
NPI Last Update Date: | 05/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |