=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528606357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESMPT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2019
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7135 NEW SANGER AVE SUITE 502
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-325-9817
-----------------------------------------------------
Fax | 254-754-2667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7135 NEW SANGER AVE STE 502
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-732-5981
-----------------------------------------------------
Fax | 254-754-2667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DENISE WISE
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 254-732-5981
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------