SOUTHLAKE SPORTS & SPINE REHAB PLLC
NPI 1497048730
Physical Therapist in Southlake, TX

Active since May 19, 2011CLIA 45D2073435 · Waiver
1050 E HIGHWAY 114, SUITE 110, SOUTHLAKE, TX 76092(817) 491-4775 Get Directions Write a Review

NPPES record last updated: May 19, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southlake Sports & Spine Rehab Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHLAKE SPORTS & SPINE REHAB PLLC (NPI 1497048730) is a healthcare organization registered as a physical therapist in Southlake, Texas and active in the NPI registry since May 2011. The organization holds a CLIA Waiver certificate valid through February 18, 2028 and lists Joel Dean Judd, Owner, as its authorized official.

NPPES Registry Identity

NPI1497048730
Entity TypeOrganization
Primary Taxonomy225100000X
Legal Business NameSOUTHLAKE SPORTS & SPINE REHAB PLLC
Location Address1050 E HIGHWAY 114, SUITE 110Southlake, TX 76092-5253
Mailing Address1109 Church StColleyville, TX 76034-5849 · (817) 498-3919 · Fax (817) 498-7080
Organization SubpartNo
Authorized OfficialJoel Dean JuddOwner · (817) 498-3919
Enumeration DateMay 19, 2011
NPI 1497048730 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
1050 E HIGHWAY 114, Southlake, TX 76092

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2073435

Southlake Sports & Spine · Southlake, TX
Active · expires Feb 18, 2028
CLIA Number45D2073435
Laboratory TypePhysician Office
Certificate Effective DateFebruary 19, 2026
Certificate Expiration DateFebruary 18, 2028
Laboratory DirectorEric I. Ray
Laboratory Phone(917) 898-7277
Laboratory LocationSouthlake Sports & Spine731 E Southlake Blvd Ste 110, Southlake, TX 76092
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southlake Sports & Spine Rehab PLLC's NPI number?

The NPI number for Southlake Sports & Spine Rehab PLLC is 1497048730. It was assigned to this organization in the NPPES registry on May 19, 2011.

Where is Southlake Sports & Spine Rehab PLLC located?

Southlake Sports & Spine Rehab PLLC is located at 1050 E Highway 114 Suite 110, Southlake, TX 76092. The listed phone number is (817) 491-4775.

What is Southlake Sports & Spine Rehab PLLC's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Does Southlake Sports & Spine Rehab PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2073435) is associated with this NPI, valid through February 18, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southlake Sports & Spine Rehab PLLC was last updated on May 19, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.