Healthcare Provider Details

I. General information

NPI: 1184746182
Provider Name (Legal Business Name): GEORGINA MARIE HOMAN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1393 AMBLER AVE
ABILENE TX
79601-2215
US

IV. Provider business mailing address

10948 NORA RD
ABILENE TX
79601-8493
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-2490
  • Fax:
Mailing address:
  • Phone: 325-669-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1138808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: