Provider Demographics
NPI:1881988780
Name:RETURN2SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:RETURN2SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MCGAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-891-6048
Mailing Address - Street 1:2835 EXCHANGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9192
Mailing Address - Country:US
Mailing Address - Phone:817-891-6048
Mailing Address - Fax:817-431-8264
Practice Address - Street 1:2835 EXCHANGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9192
Practice Address - Country:US
Practice Address - Phone:817-891-6048
Practice Address - Fax:817-431-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124198627OtherNPI