Provider Demographics
NPI:1295815702
Name:HEB PHYSICAL THERAPY AND SPORTS REHABILITATION CLINIC PC
Entity type:Organization
Organization Name:HEB PHYSICAL THERAPY AND SPORTS REHABILITATION CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER STAFF PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-545-7500
Mailing Address - Street 1:2901 B MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-545-7500
Mailing Address - Fax:817-545-9793
Practice Address - Street 1:2901 MARTIN DR STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3839
Practice Address - Country:US
Practice Address - Phone:817-545-7500
Practice Address - Fax:817-545-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029049261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy