Provider Demographics
NPI:1659353597
Name:CROSS TIMBERS PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:CROSS TIMBERS PHYSICAL THERAPY CENTER
Other - Org Name:SMART INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:R DENE
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:817-377-3422
Mailing Address - Street 1:3600 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2534
Mailing Address - Country:US
Mailing Address - Phone:817-377-3422
Mailing Address - Fax:817-735-8615
Practice Address - Street 1:3600 W. 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2534
Practice Address - Country:US
Practice Address - Phone:817-377-3422
Practice Address - Fax:817-735-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067213261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086000902Medicaid
TX086000901Medicaid
TX086000902Medicaid