1386473650 NPI number — PSYCHOSOCIAL REHABILITATION SERVICES OF SOUTH TEXAS

Table of content: DR. TRACY ALISHA THOMAS PT, PH. D. (NPI 1821360629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386473650 NPI number — PSYCHOSOCIAL REHABILITATION SERVICES OF SOUTH TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOSOCIAL REHABILITATION SERVICES OF SOUTH TEXAS
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:
1386473650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52 TOWNHOUSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78412-4269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 TOWNHOUSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78412-4269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-775-8956
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
LUCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CASE MANAGER
Authorized Official Telephone Number:
361-775-8956

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com