OrganizationActive
Detoelarization LLC
NPI 1376195172 · Electrodiagnostic Medicine Physician · Fort Worth, TX
Provider details
- NPI number
- 1376195172
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gina Sullivan, Billing Manager(817) 529-8488
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(66/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
111 Boland St Ste 211
Fort Worth, TX 76107-1265
Phone: (817) 529-8488
Fax: (903) 328-6568
Street-level locationGet directions
Mailing address
111 Boland St Ste 211
Fort Worth, TX 76107-1265
Registry dates
- Enumerated
- 2019-07-11
- Last updated
- 2019-07-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.