Provider Demographics
NPI:1073669974
Name:MED SPORT THERAPY & REHAB INC
Entity Type:Organization
Organization Name:MED SPORT THERAPY & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V- PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SCHWEYHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-572-7942
Mailing Address - Street 1:P.O. BOX 590
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76098
Mailing Address - Country:US
Mailing Address - Phone:817-419-6111
Mailing Address - Fax:817-419-9582
Practice Address - Street 1:4898 LITTLE ROAD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-419-6111
Practice Address - Fax:817-419-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXREG 604100000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty