Provider Demographics
NPI:1932317583
Name:VARSITY ORTHOPEDICS, P.A.
Entity Type:Organization
Organization Name:VARSITY ORTHOPEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHY
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:QUATRO
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-431-1017
Mailing Address - Street 1:501 W HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3163
Mailing Address - Country:US
Mailing Address - Phone:817-268-2758
Mailing Address - Fax:817-268-2802
Practice Address - Street 1:9545 N BEACH ST STE 133
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6471
Practice Address - Country:US
Practice Address - Phone:817-431-1017
Practice Address - Fax:817-431-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8341207XP3100X, 207XX0005X, 2080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110604901Medicaid
TX1366417883OtherNPI NUMBER
TXF89296Medicare UPIN
TX00T98PMedicare ID - Type Unspecified