Provider Demographics
NPI:1568480531
Name:COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Other - Org Name:PHYSICAL THERAPY OF FLOWER MOUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP,AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:4401 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4401 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1794
Practice Address - Country:US
Practice Address - Phone:972-691-1331
Practice Address - Fax:972-691-1731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456844Medicare Oscar/Certification