Provider Demographics
NPI:1457728230
Name:PREMIER REHAB PHYSICAL THERAPY AND AQUATICS
Entity Type:Organization
Organization Name:PREMIER REHAB PHYSICAL THERAPY AND AQUATICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:817-498-8585
Mailing Address - Street 1:5060 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7004
Mailing Address - Country:US
Mailing Address - Phone:817-498-8585
Mailing Address - Fax:
Practice Address - Street 1:2720 WESTERN CENTER BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-4302
Practice Address - Country:US
Practice Address - Phone:817-847-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12644582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty