Provider Demographics
NPI:1023027471
Name:RIATA THERAPY SPECIALISTS PLLC
Entity Type:Organization
Organization Name:RIATA THERAPY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:817-898-7090
Mailing Address - Street 1:651 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7037
Mailing Address - Country:US
Mailing Address - Phone:817-898-7090
Mailing Address - Fax:817-562-2950
Practice Address - Street 1:651 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7037
Practice Address - Country:US
Practice Address - Phone:817-898-7090
Practice Address - Fax:817-562-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655740000261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00217YMedicare ID - Type Unspecified