| Organization Name: | GLEN ROSE PHYSICAL THERAPY AND SPORTS REHAB, P.C. |
| NPI Number: | 1639228844 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLARK KEVIN COLE (OWNER OPERATOR) |
| Mailing Address: | 1005 Ne Big Bend Trl Suite 3 Glen Rose |
| State: | TX US |
| Postal Code: | 760434942 |
| Phone Number: | 2548982121 |
| Fax Number: | 2548981616 |
| NPI Enumeration Date: | 01/09/2007 |
| NPI Last Update Date: | 07/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1078459 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| 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 |