Provider Demographics
NPI:1407066574
Name:TARRANT SPORTS & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TARRANT SPORTS & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-741-8122
Mailing Address - Street 1:801 S MAIN ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7026
Mailing Address - Country:US
Mailing Address - Phone:817-741-8122
Mailing Address - Fax:
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:SUITE 117
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7026
Practice Address - Country:US
Practice Address - Phone:817-741-8122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1922199116OtherNPI INDIVIDUAL
TX8T6880OtherBLUE CROSS BLUE SHIELD