Healthcare Provider Details

I. General information

NPI: 1215960836
Provider Name (Legal Business Name): PHYSICAL THERAPY SPECIALTY CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12741 RESEARCH BLVD SUITE 505-B
AUSTIN TX
78759-4388
US

IV. Provider business mailing address

12741 RESEARCH BLVD SUITE 505-B
AUSTIN TX
78759-4388
US

V. Phone/Fax

Practice location:
  • Phone: 512-219-5377
  • Fax: 512-219-5376
Mailing address:
  • Phone: 512-219-5377
  • Fax: 512-219-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1051415
License Number StateTX

VIII. Authorized Official

Name: MS. COLLEEN FRANCES BASLER
Title or Position: THERAPIST/PRESIDENT
Credential: P.T.
Phone: 512-219-5377