Provider Demographics
NPI:1194190090
Name:OSBORNE, DREW WESLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:WESLEY
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 BLACKBURN ST
Mailing Address - Street 2:APT 8310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1588
Mailing Address - Country:US
Mailing Address - Phone:501-652-0382
Mailing Address - Fax:
Practice Address - Street 1:3355 BLACKBURN ST
Practice Address - Street 2:APT 8310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1588
Practice Address - Country:US
Practice Address - Phone:501-652-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1185450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist