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General NPI Number Information
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NPI Number | 1629792809
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Entity Type | Organization
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Legal Business Name | ANGELO SPORTS PERFORMANCE AND REHAB LLC
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Dates
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Enumeration Date | 09/30/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 4105 S CHADBOURNE ST
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City | SAN ANGELO
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State | TX
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Zip | 76904-9152
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Country | US
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Telephone | 619-547-7039
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Fax | 325-225-0613
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Provider Business Mailing Address
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Address Line | 12381 S US HIGHWAY 277
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City | SAN ANGELO
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State | TX
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Zip | 76904-4498
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Country | US
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Telephone | 619-547-7039
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Fax | 325-225-0613
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Authorized Official
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Title or Position | OWNER AND PHYSICAL THERAPIST
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Name | DR. TRYON ROBERT FIELDS
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Credential | PT, DPT
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Telephone | 619-547-7039
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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 |
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License Number State |
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