Provider Demographics
NPI:1326584111
Name:FORT WORTH HEAD NECK AND JAW PLLC
Entity Type:Organization
Organization Name:FORT WORTH HEAD NECK AND JAW PLLC
Other - Org Name:RIED PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:214-264-4839
Mailing Address - Street 1:2939 CROCKETT ST #312
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2955
Mailing Address - Country:US
Mailing Address - Phone:214-264-4839
Mailing Address - Fax:817-841-1295
Practice Address - Street 1:2939 CROCKETT ST #312
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2955
Practice Address - Country:US
Practice Address - Phone:214-264-4839
Practice Address - Fax:817-841-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX681160000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy