1053674192 NPI number — TIER 1 PHYSICAL THERAPY AND SPORTS MEDICINE PLLC

Table of content: (NPI 1053674192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053674192 NPI number — TIER 1 PHYSICAL THERAPY AND SPORTS MEDICINE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIER 1 PHYSICAL THERAPY AND SPORTS MEDICINE PLLC
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:
1053674192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4849 N MESA ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-5919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-351-6600
Provider Business Mailing Address Fax Number:
915-351-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 N MESA ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-585-1888
Provider Business Practice Location Address Fax Number:
915-585-1889
Provider Enumeration Date:
06/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-585-1888

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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