Provider Demographics
NPI:1972614030
Name:ORTHOPEDIC PHYSICAL THERAPY SPECIALISTS P C
Entity Type:Organization
Organization Name:ORTHOPEDIC PHYSICAL THERAPY SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:214-239-0990
Mailing Address - Street 1:PO BOX 670769
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0769
Mailing Address - Country:US
Mailing Address - Phone:214-239-0990
Mailing Address - Fax:214-239-0991
Practice Address - Street 1:7115 GREENVILLE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5100
Practice Address - Country:US
Practice Address - Phone:214-239-0990
Practice Address - Fax:214-239-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629130001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0085DLOtherBLUE CROSS BLUE SHIELD
TX0085DLOtherBLUE CROSS BLUE SHIELD