Provider Demographics
NPI:1811104086
Name:RICHARDSON SPINE AND SPORTS THERAPY CENTER LLC
Entity type:Organization
Organization Name:RICHARDSON SPINE AND SPORTS THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-575-4040
Mailing Address - Street 1:375 MUNICIPAL DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3559
Mailing Address - Country:US
Mailing Address - Phone:214-575-4040
Mailing Address - Fax:214-575-4041
Practice Address - Street 1:375 MUNICIPAL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3559
Practice Address - Country:US
Practice Address - Phone:214-575-4040
Practice Address - Fax:214-575-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X868Medicare PIN