Provider Demographics
NPI:1164172912
Name:CORE PHYSICAL THERAPY KELLER
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY KELLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-200-6492
Mailing Address - Street 1:901 W BARDIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6000
Mailing Address - Country:US
Mailing Address - Phone:817-200-6492
Mailing Address - Fax:817-549-8116
Practice Address - Street 1:601 S MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7027
Practice Address - Country:US
Practice Address - Phone:501-580-8352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTLE SURGICAL MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology