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General NPI Number Information
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NPI Number | 1043452857
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Entity Type | Organization
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Legal Business Name | TEXOMA PHYSICAL THERAPY & REHABILITATION CLINIC, LLC
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 101 WEST MAIN
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City | TISHOMINGO
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State | OK
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Zip | 73460
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Country | US
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Telephone | 580-371-2334
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Fax | 580-371-2351
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Provider Business Mailing Address
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Address Line | PO BOX 820
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City | TISHOMINGO
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State | OK
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Zip | 73460-0820
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Country | US
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Telephone | 580-371-2334
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Fax | 580-371-2351
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ASHLEY L. WOOD
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Credential |
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Telephone | 580-371-6191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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