Healthcare Provider Details

I. General information

NPI: 1841200524
Provider Name (Legal Business Name): PANHANDLE SPORTS MEDICINE INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6022 W 48TH AVE
AMARILLO TX
79109-7504
US

IV. Provider business mailing address

6022 W 48TH AVE
AMARILLO TX
79109-7504
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-5244
  • Fax: 806-353-6151
Mailing address:
  • Phone: 806-355-5244
  • Fax: 806-353-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number652790000
License Number StateTX

VIII. Authorized Official

Name: SHELLY JAY
Title or Position: DIRECTOR
Credential: PT
Phone: 806-355-5244