Provider Demographics
NPI:1528240645
Name:HULEN SPORTS PHYSICAL THERAPY
Entity type:Organization
Organization Name:HULEN SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:817-263-9222
Mailing Address - Street 1:3017 JOYCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-4013
Mailing Address - Country:US
Mailing Address - Phone:817-263-9222
Mailing Address - Fax:817-838-1670
Practice Address - Street 1:3017 JOYCE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4013
Practice Address - Country:US
Practice Address - Phone:817-263-9222
Practice Address - Fax:817-838-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118321261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00153ZMedicare PIN