Healthcare Provider Details

I. General information

NPI: 1790890937
Provider Name (Legal Business Name): PHYSICAL THERAPY ASSOCIATES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 S LOOP 289 SUITE 101
LUBBOCK TX
79423-8312
US

IV. Provider business mailing address

3223 S LOOP 289 STE 101
LUBBOCK TX
79423-8312
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-5522
  • Fax: 806-785-7582
Mailing address:
  • Phone: 806-792-5522
  • Fax: 806-785-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number555010000
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number653130000
License Number StateTX

VIII. Authorized Official

Name: MRS. LIESL LYNN OLSON
Title or Position: OWNER
Credential: MS, PT
Phone: 806-792-5522