Healthcare Provider Details

I. General information

NPI: 1679604078
Provider Name (Legal Business Name): PHYSICAL THERAPY UNLIMITED, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 FM 2673
CANYON LAKE TX
78133-4510
US

IV. Provider business mailing address

1356 FM 2673
CANYON LAKE TX
78133-4510
US

V. Phone/Fax

Practice location:
  • Phone: 830-907-2145
  • Fax: 830-964-2373
Mailing address:
  • Phone: 830-907-2145
  • Fax: 830-964-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number603080000
License Number StateTX

VIII. Authorized Official

Name: MR. ROBERT RODRIGUEZ
Title or Position: PRESIDENY OWNER PHYSICAL THERAPIST
Credential: LPT
Phone: 830-907-2145