Provider Demographics
NPI:1235288176
Name:THE RANCH SPORTS MEDICINE AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:THE RANCH SPORTS MEDICINE AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BELL
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:II
Authorized Official - Credentials:PT
Authorized Official - Phone:972-401-4774
Mailing Address - Street 1:10010 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5001
Mailing Address - Country:US
Mailing Address - Phone:972-401-4774
Mailing Address - Fax:972-401-0800
Practice Address - Street 1:10010 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5001
Practice Address - Country:US
Practice Address - Phone:972-401-4774
Practice Address - Fax:972-401-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061596261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82672TOtherBCBS PROVIDER #
TX82672TOtherBCBS PROVIDER #