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General NPI Number Information
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NPI Number | 1487974317
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Entity Type | Organization
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Legal Business Name | COUNTRY OUTPATIENT PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 205 E. COLLEGE ST
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City | MASON
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State | TX
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Zip | 76856
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Country | US
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Telephone | 325-347-9600
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Fax | 325-347-9700
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Provider Business Mailing Address
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Address Line | PO BOX 1007 205 E. COLLEGE ST
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City | MASON
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State | TX
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Zip | 76856
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Country | US
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Telephone | 325-347-9600
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Fax | 325-347-9700
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Authorized Official
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Title or Position | RN, ADMINISTRATOR
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Name | MRS. DAWN A. FARMER
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Credential | RN
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Telephone | 325-347-4762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 668460000
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License Number State | TX
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