Provider Demographics
NPI:1174820732
Name:SPINE WORKS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SPINE WORKS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-616-0700
Mailing Address - Street 1:8801 NORTH TARRANT PARKWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182
Mailing Address - Country:US
Mailing Address - Phone:817-616-0700
Mailing Address - Fax:
Practice Address - Street 1:8801 NORTH TARRANT PARKWAY
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182
Practice Address - Country:US
Practice Address - Phone:817-616-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy