Spine Works Therapy-Southlake, P.L.L.C.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

L5053 Issued in TX

Legal business name

SPINE WORKS THERAPY-SOUTHLAKE, P.L.L.C.

Practice address

1001 W Southlake Blvd
Southlake, TX 76092-6010

Phone

(817) 310-0421

Fax

(817) 310-5870

NPI assigned

Jun 7, 2011

Last updated

Jun 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffery B Phelps, M.D.

Title

President

Phone

(817) 616-0700

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307404800000",
    "number": "1619261757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST SOUTHLAKE BLVD.",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-310-0421",
            "fax_number": "817-310-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W SOUTHLAKE BLVD",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926010",
            "telephone_number": "817-310-0421",
            "fax_number": "817-310-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE WORKS THERAPY-SOUTHLAKE, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-07",
        "last_updated": "2011-06-07",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-616-0700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "L5053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsie Jordyn Speckner, PA-C
• Grace Schuler Spencer, PSYD
• Nicole Marie Spexarth
• Maria Gabriela Spicer, LPC-A
• Spine Team Texas PA
• Giuseppe Sposito, DPT
• Trisha J Sprekelmeyer
• Kathryn Jo Sprengel, LPC ASSOCIATE
• Spry Medical Group Corporation
• Squire Surgical Services PLLC

• Clinic/Center in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.