Provider Demographics
NPI:1629547534
Name:DFW INTEGRATIVE REHABILITATION
Entity Type:Organization
Organization Name:DFW INTEGRATIVE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/INSURANCE COOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:817-498-8449
Mailing Address - Street 1:470 W HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2939
Mailing Address - Country:US
Mailing Address - Phone:817-498-8449
Mailing Address - Fax:817-281-4829
Practice Address - Street 1:470 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2939
Practice Address - Country:US
Practice Address - Phone:817-498-8449
Practice Address - Fax:817-281-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX684950000OtherEXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS