Provider Demographics
NPI:1952854846
Name:GCBG INVESTMENTS LLC
Entity Type:Organization
Organization Name:GCBG INVESTMENTS LLC
Other - Org Name:VICTORY SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-824-3356
Mailing Address - Street 1:2450 LAKESIDE PKWY STE 150-145
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4120
Mailing Address - Country:US
Mailing Address - Phone:972-533-2950
Mailing Address - Fax:
Practice Address - Street 1:2500 LAKESIDE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4254
Practice Address - Country:US
Practice Address - Phone:214-285-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX536374Medicare PIN