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NPI Code Detail

MEDICARE: VALENTINE PHYSICAL THERAPY, LLC

MEDICARE: VALENTINE PHYSICAL THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistTX

General Provider Information

NPI Number : 1063806818
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALENTINE PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 1212 N HIGHWAY 377 STE 111
Second Line :
City : ROANOKE
State : TX
Zip : 76262-6916
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1212 N HIGHWAY 377 STE 111
Second Line :
City : ROANOKE
State : TX
Zip : 76262-6916
Country : US
Telephone Number : 214-494-6287
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : GEROLD WAYNE VALENTINE JR.
Credential : PT
Telephone Number : 214-494-6287
Provider Enumeration Date : 03/18/2015
Last Update Date : 03/26/2015

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Directions to “VALENTINE PHYSICAL THERAPY, LLC ” Practice Location

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