Provider Demographics
NPI:1790362580
Name:FT. WORTH REHABILITATION, INC.
Entity Type:Organization
Organization Name:FT. WORTH REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC, OPA-C
Authorized Official - Phone:214-396-4488
Mailing Address - Street 1:PO BOX 497014
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-7014
Mailing Address - Country:US
Mailing Address - Phone:214-396-4488
Mailing Address - Fax:888-389-8141
Practice Address - Street 1:3510 LUTHER LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1416
Practice Address - Country:US
Practice Address - Phone:214-396-4488
Practice Address - Fax:888-389-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty