1073601670 NPI number — SYNERGY PHYSICAL THERAPY OF ODESSA LP

Table of content: MRS. TAMARA LEA HALFORD LPN (NPI 1053557868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073601670 NPI number — SYNERGY PHYSICAL THERAPY OF ODESSA LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY PHYSICAL THERAPY OF ODESSA LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073601670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 TOWER DR
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79761-4243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-335-8777
Provider Business Mailing Address Fax Number:
432-335-8787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 TOWER DR
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-335-8777
Provider Business Practice Location Address Fax Number:
432-335-8787
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUSH
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
432-335-8777

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 177897901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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