Provider Demographics
NPI:1508534611
Name:CK PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CK PHYSICAL THERAPY LLC
Other - Org Name:3RD GEAR PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOTTWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:210-216-6367
Mailing Address - Street 1:141 CRIMSON SKY CT
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1316
Mailing Address - Country:US
Mailing Address - Phone:210-216-6367
Mailing Address - Fax:
Practice Address - Street 1:2921 LACKLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4173
Practice Address - Country:US
Practice Address - Phone:210-216-6367
Practice Address - Fax:469-532-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No251E00000XAgenciesHome Health