=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649079864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACK TO THE BASICS SOLUTIONS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 03/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 426 S GUN BARREL LN
-----------------------------------------------------
City | GUN BARREL CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75156-3855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-640-9985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 58
-----------------------------------------------------
City | MABANK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75147-0058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-640-9985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | MRS. RENEE CATHERINE MAXWELL
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 432-640-9985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------