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General NPI Number Information
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NPI Number | 1790890937
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY ASSOCIATES, LP
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 3223 S LOOP 289 SUITE 101
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City | LUBBOCK
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State | TX
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Zip | 79423-8312
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Country | US
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Telephone | 806-792-5522
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Fax | 806-785-7582
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Provider Business Mailing Address
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Address Line | 3223 S LOOP 289 STE 101
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City | LUBBOCK
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State | TX
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Zip | 79423-8312
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Country | US
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Telephone | 806-792-5522
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Fax | 806-785-7582
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LIESL LYNN OLSON
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Credential | MS, PT
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Telephone | 806-792-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 555010000
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 653130000
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License Number State | TX
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