Healthcare Provider Details

I. General information

NPI: 1053514430
Provider Name (Legal Business Name): PHYSICAL THERAPY OF GUN BARREL CITY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 S. PALESTINE
ATHENS TX
75751
US

IV. Provider business mailing address

PO BOX 2028
ATHENS TX
75751
US

V. Phone/Fax

Practice location:
  • Phone: 903-675-0077
  • Fax: 903-675-0078
Mailing address:
  • Phone: 903-675-0077
  • Fax: 903-675-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1019057
License Number StateTX

VIII. Authorized Official

Name: MR. DON F. VALLIE
Title or Position: THERAPIST IN CHARGE/CO-OWNER
Credential: PT
Phone: 903-675-0077