Provider Demographics
NPI:1619678042
Name:TUMBLE AUTHORITY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TUMBLE AUTHORITY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-386-4144
Mailing Address - Street 1:10404 MORNING DEW ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-4922
Mailing Address - Country:US
Mailing Address - Phone:325-267-4111
Mailing Address - Fax:
Practice Address - Street 1:5608 MALVEY AVE STE 204
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5108
Practice Address - Country:US
Practice Address - Phone:817-386-4144
Practice Address - Fax:817-386-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty