1790890937 NPI number — PHYSICAL THERAPY ASSOCIATES, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790890937 NPI number — PHYSICAL THERAPY ASSOCIATES, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL THERAPY ASSOCIATES, 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:
1790890937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3223 S LOOP 289
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79423-8312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-792-5522
Provider Business Mailing Address Fax Number:
806-785-7582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3223 S LOOP 289
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79423-8312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-792-5522
Provider Business Practice Location Address Fax Number:
806-785-7582
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLSON
Authorized Official First Name:
LIESL
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
806-792-5522

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  653130000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: 555010000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 168327801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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