Provider Demographics
NPI:1821206921
Name:SNEAKERS REHABILITATION, INC
Entity Type:Organization
Organization Name:SNEAKERS REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-735-3603
Mailing Address - Street 1:4960 SHADY OAK TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4468
Mailing Address - Country:US
Mailing Address - Phone:214-735-3603
Mailing Address - Fax:877-871-5352
Practice Address - Street 1:2300 COIT RD STE 207
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3770
Practice Address - Country:US
Practice Address - Phone:214-735-3603
Practice Address - Fax:877-871-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00525TMedicare ID - Type Unspecified