Fort Worth Ent,p.a.

NPI #1336353366 in Fort Worth, Texas

Provider Information

NPI Number: 1336353366
Entity Type: Organization
Organization Name: Fort Worth Ent,p.a.
Primary Specialty: Specialist
Enumeration Date: May 9, 2007
Last Updated: Jan 24, 2011

Practice Location

Address: 1250 8TH AVE
Address 2: SUITE 135
City: Fort Worth
State: Texas
ZIP Code: 76104
Phone: (817) 335-8151

Authorized Official

Name: MRS. VICKY L. VANVLECK
Title: PRACTICE MANAGER
Phone: (817) 335-8151

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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