Provider Demographics
NPI:1376885939
Name:STRETCH REHABILITATION
Entity Type:Organization
Organization Name:STRETCH REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:972-804-6105
Mailing Address - Street 1:8330 LBJ FWY
Mailing Address - Street 2:255
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1166
Mailing Address - Country:US
Mailing Address - Phone:972-804-6105
Mailing Address - Fax:
Practice Address - Street 1:8330 LBJ FWY
Practice Address - Street 2:255
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1166
Practice Address - Country:US
Practice Address - Phone:972-804-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service