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General NPI Number Information
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NPI Number | 1841200524
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Entity Type | Organization
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Legal Business Name | PANHANDLE SPORTS MEDICINE INSTITUTE, PA
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 6022 W 48TH AVE
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City | AMARILLO
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State | TX
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Zip | 79109-7504
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Country | US
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Telephone | 806-355-5244
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Fax | 806-353-6151
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Provider Business Mailing Address
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Address Line | 6022 W 48TH AVE
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City | AMARILLO
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State | TX
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Zip | 79109-7504
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Country | US
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Telephone | 806-355-5244
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Fax | 806-353-6151
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHELLY JAY
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Credential | PT
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Telephone | 806-355-5244
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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 | 652790000
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License Number State | TX
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