Provider Demographics
NPI:1003929357
Name:SPORTS REHABILITATION SPECIALISTS, INC
Entity Type:Organization
Organization Name:SPORTS REHABILITATION SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PICKREL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-877-8977
Mailing Address - Street 1:1901 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-877-8977
Mailing Address - Fax:817-877-1106
Practice Address - Street 1:1901 COOPER ST
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-877-8977
Practice Address - Fax:817-877-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
TX5292500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00001SMedicare UPIN