Spine Works Therapy-Southlake, P.l.l.c.

NPI #1619261757 in Southlake, Texas

Provider Information

NPI Number: 1619261757
Entity Type: Organization
Organization Name: Spine Works Therapy-Southlake, P.l.l.c.
Primary Specialty: Clinic/Center
Enumeration Date: Jun 7, 2011
Last Updated: Jun 7, 2011

Practice Location

Address: 1001 W SOUTHLAKE BLVD
City: Southlake
State: Texas
ZIP Code: 76092-6010
Phone: (817) 310-0421

Authorized Official

Name: JEFFERY B PHELPS, M.D.
Title: PRESIDENT
Phone: (817) 616-0700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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