Provider Demographics
NPI:1093844664
Name:TEXAS ORTHOPEDICS SPORTS & REHABILITATION ASSOCIATES PA
Entity Type:Organization
Organization Name:TEXAS ORTHOPEDICS SPORTS & REHABILITATION ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-439-1011
Mailing Address - Street 1:4700 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4107
Mailing Address - Country:US
Mailing Address - Phone:512-349-1000
Mailing Address - Fax:512-439-1081
Practice Address - Street 1:3755 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE 160
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6645
Practice Address - Country:US
Practice Address - Phone:512-439-1005
Practice Address - Fax:512-439-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0366280005Medicare NSC