Provider Demographics
NPI:1699980250
Name:COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:413 W BETHEL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2445 W OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4325
Practice Address - Country:US
Practice Address - Phone:940-320-6030
Practice Address - Fax:940-320-3113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPPELL SPINE & SPORTS REHAB LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5032490002Medicare NSC