Provider Demographics
NPI:1417508730
Name:AVIATOR REHAB SPECIALISTS LLC
Entity Type:Organization
Organization Name:AVIATOR REHAB SPECIALISTS LLC
Other - Org Name:AVIATOR SPORTS PERFORMANCE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS & OPERATIONS SENIOR EXEC
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-961-4920
Mailing Address - Street 1:9500 RAY WHITE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9105
Mailing Address - Country:US
Mailing Address - Phone:972-961-4920
Mailing Address - Fax:469-250-8488
Practice Address - Street 1:6151 COUNTY ROAD 124
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4837
Practice Address - Country:US
Practice Address - Phone:972-645-1833
Practice Address - Fax:972-645-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX686000000OtherEXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS