1336852151 NPI number — DR. MISTIE LEA MCBRIDE DPT

Table of content: DR. MISTIE LEA MCBRIDE DPT (NPI 1336852151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336852151 NPI number — DR. MISTIE LEA MCBRIDE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCBRIDE
Provider First Name:
MISTIE
Provider Middle Name:
LEA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

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:
1336852151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1761
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79831-1761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-413-3900
Provider Business Mailing Address Fax Number:
432-386-2847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 HWY 118 NORTH
Provider Second Line Business Practice Location Address:
PHYSICAL THERAPY DEPT
Provider Business Practice Location Address City Name:
ALPINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-837-0220
Provider Business Practice Location Address Fax Number:
432-837-0295
Provider Enumeration Date:
12/27/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1076818 , 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)