Healthcare Provider Details

I. General information

NPI: 1093726093
Provider Name (Legal Business Name): CANYON PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7726 WHITE PLAINS AVE
AMARILLO TX
79121-1774
US

IV. Provider business mailing address

907 23RD ST
CANYON TX
79015-4645
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-6544
  • Fax: 806-355-1587
Mailing address:
  • Phone: 806-655-6824
  • Fax: 806-655-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISS VICTORIA PEREZ
Title or Position: BUSINESS OFFICE
Credential:
Phone: 806-353-6544