Provider Demographics
NPI:1710348552
Name:WOERNER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WOERNER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, WCS, CLT
Authorized Official - Phone:682-235-3816
Mailing Address - Street 1:PO BOX 12321
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8321
Mailing Address - Country:US
Mailing Address - Phone:682-235-3816
Mailing Address - Fax:817-887-2719
Practice Address - Street 1:1000 BONNIE BRAE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-4355
Practice Address - Country:US
Practice Address - Phone:682-235-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183949261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L3503OtherMEDICARE