Provider Demographics
NPI:1366517542
Name:SPORTS THERAPY AND REHABILITATION SERVICES
Entity type:Organization
Organization Name:SPORTS THERAPY AND REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAHL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-249-6336
Mailing Address - Street 1:1555 MERRIMAC CIRCLE
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107
Mailing Address - Country:US
Mailing Address - Phone:817-870-4949
Mailing Address - Fax:817-338-2940
Practice Address - Street 1:1555 MERRIMAC CIRCLE
Practice Address - Street 2:STE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-870-4949
Practice Address - Fax:817-338-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035GDOtherBCBS
TX686182OtherUNITED HEALTH CARE ACN
TX3815621OtherCIGNA
TX686182OtherUNITED HEALTH CARE ACN
TXX61316Medicare UPIN