Provider Demographics
NPI:1073403093
Name:FOREST PARK MANAGEMENT
Entity type:Organization
Organization Name:FOREST PARK MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-307-9520
Mailing Address - Street 1:2111 FOREST PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1726
Mailing Address - Country:US
Mailing Address - Phone:817-307-9520
Mailing Address - Fax:
Practice Address - Street 1:3800 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9403
Practice Address - Country:US
Practice Address - Phone:817-307-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty