Organization · Type 2 NPI

Self Richard dba

Private Vehicle · Fort Worth, TX

NPI number 1003062472 Active

Practice location

6701 Calmont Ave Apt 101
Fort Worth, TX 76116-4239

Call (817) 304-2892 Map

Fax (817) 246-4764

Specialties and licenses

TaxonomyCodeLicense
Physical Disabilities Residential Treatment Facility 320700000X09332825 (TX)
Private Vehicle Primary 347C00000X09332825 (TX)

Private Vehicle: An individual paid to provide non-emergency transportation using their privately owned/leased vehicle.

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About NPI 1003062472

Self Richard dba's National Provider Identifier is 1003062472, issued on Aug 17, 2008. The primary taxonomy on file is Private Vehicle (347C00000X), and the practice location is in Fort Worth, TX. The record was last updated on Aug 17, 2008.