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General NPI Number Information
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NPI Number | 1376204735
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Entity Type | Organization
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Legal Business Name | PATHWAY REHABILITATION LLC
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1140 FM 1189 STE 115
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City | MILLSAP
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State | TX
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Zip | 76066-3540
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Country | US
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Telephone | 254-485-1482
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Fax |
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Provider Business Mailing Address
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Address Line | 582 S SUGARTREE DR
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City | LIPAN
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State | TX
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Zip | 76462-4341
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Country | US
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Telephone | 254-485-1482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEX GARRETT
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Credential | PTA
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Telephone | 254-485-1482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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