Provider Demographics
NPI:1871043646
Name:CORE REHABILITATION
Entity Type:Organization
Organization Name:CORE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:817-337-3400
Mailing Address - Street 1:11751 ALTA VISTA RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6441
Mailing Address - Country:US
Mailing Address - Phone:817-337-3400
Mailing Address - Fax:
Practice Address - Street 1:11751 ALTA VISTA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6441
Practice Address - Country:US
Practice Address - Phone:817-337-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234302261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy