Provider Demographics
NPI:1679876684
Name:CONCENTRA
Entity Type:Organization
Organization Name:CONCENTRA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REDDOUT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:817-441-1091
Mailing Address - Street 1:139 RIM ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-3983
Mailing Address - Country:US
Mailing Address - Phone:817-441-1091
Mailing Address - Fax:
Practice Address - Street 1:139 RIM ROCK RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-3983
Practice Address - Country:US
Practice Address - Phone:817-441-1091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112436261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy