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General NPI Number Information
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NPI Number | 1386358604
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Entity Type | Organization
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Legal Business Name | TEXOMA MOBILE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 4344 CUNNINGHAM DR
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2611
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Country | US
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Telephone | 302-745-0023
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Fax | 940-241-4669
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Provider Business Mailing Address
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Address Line | PO BOX 9596
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City | WICHITA FALLS
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State | TX
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Zip | 76308-9596
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Country | US
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Telephone | 302-745-0023
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Fax | 940-241-4669
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / OWNER
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Name | MRS. ALISHA M. HENDERSON
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Credential | PT
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Telephone | 302-745-0023
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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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