Southlake Sports & Spine Rehab Pllc

NPI #1497048730 in Southlake, Texas

Provider Information

NPI Number: 1497048730
Entity Type: Organization
Organization Name: Southlake Sports & Spine Rehab Pllc
Primary Specialty: Physical Therapist
Enumeration Date: May 19, 2011
Last Updated: May 19, 2011

Practice Location

Address: 1050 E HIGHWAY 114
Address 2: SUITE 110
City: Southlake
State: Texas
ZIP Code: 76092-5253
Phone: (817) 491-4775

Authorized Official

Name: JOEL DEAN JUDD, PT, MPT, OCS
Title: OWNER
Phone: (817) 498-3919

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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