Southlake Sports & Spine Rehab PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SOUTHLAKE SPORTS & SPINE REHAB PLLC

Practice address

1050 E Highway 114
Suite 110
Southlake, TX 76092-5253

Phone

(817) 491-4775

NPI assigned

May 19, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joel Dean Judd, PT, MPT, OCS

Title

Owner

Phone

(817) 498-3919

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305763200000",
    "number": "1497048730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 CHURCH ST",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760345849",
            "telephone_number": "817-498-3919",
            "fax_number": "817-498-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 E HIGHWAY 114",
            "address_2": "SUITE 110",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925253",
            "telephone_number": "817-491-4775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE SPORTS & SPINE REHAB PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-19",
        "last_updated": "2011-05-19",
        "status": "A",
        "authorized_official_last_name": "JUDD",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-498-3919",
        "authorized_official_credential": "PT, MPT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southlake Plastic Surgery
• Southlake Psychological Associates, PLLC
• Southlake Serenity Psychiatry
• Southlake Sleep Center, LTD
• Southlake Specialty Hospital, LLC
• Southlake Surgery Center, LLC
• Southlake Vision Group PLLC
• Southlake Weight Loss, LLC
• Southlake Wound Care & Hyperbarics
• Kimberly Michelle Sowell, MS PT

• Physical Therapist in Southlake, TX
• Providers in Southlake, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.