Provider Demographics
NPI:1437764008
Name:FORT WORTH CANCER CARE
Entity Type:Organization
Organization Name:FORT WORTH CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:469-607-5966
Mailing Address - Street 1:1020 MACON ST STE 9
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4562
Mailing Address - Country:US
Mailing Address - Phone:469-607-5966
Mailing Address - Fax:
Practice Address - Street 1:1020 MACON ST STE 9
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4562
Practice Address - Country:US
Practice Address - Phone:469-607-5966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty