Provider Demographics
NPI:1699835496
Name:SOUTHWEST REHABILITATION CENTER OF ARLINGTON, P.A.
Entity Type:Organization
Organization Name:SOUTHWEST REHABILITATION CENTER OF ARLINGTON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-461-6374
Mailing Address - Street 1:1216 FLORIDA DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2387
Mailing Address - Country:US
Mailing Address - Phone:817-461-6374
Mailing Address - Fax:817-461-8550
Practice Address - Street 1:1216 FLORIDA DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2387
Practice Address - Country:US
Practice Address - Phone:817-461-6374
Practice Address - Fax:817-461-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8215111N00000X
TXN4225208D00000X
TX1079499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13615Medicare UPIN
TX8F5881Medicare UPIN