Provider Demographics
NPI:1447669312
Name:TARRANT COUNTY INSTITUTE OF PHYSICAL MEDICINE LLP
Entity type:Organization
Organization Name:TARRANT COUNTY INSTITUTE OF PHYSICAL MEDICINE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-346-7800
Mailing Address - Street 1:6901 RIVER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-8465
Mailing Address - Country:US
Mailing Address - Phone:817-732-2171
Mailing Address - Fax:817-732-2179
Practice Address - Street 1:6116 OAKBEND TRL
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3925
Practice Address - Country:US
Practice Address - Phone:817-346-7800
Practice Address - Fax:817-346-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty