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General NPI Number Information
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NPI Number | 1912398348
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Entity Type | Organization
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Legal Business Name | OBACH PHYSICAL THERAPY CLINIC LLC
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 200 COUNTY ROAD 3801
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City | BULLARD
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State | TX
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Zip | 75757
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Country | US
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Telephone | 903-894-4633
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Fax | 903-894-4648
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Provider Business Mailing Address
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Address Line | 4882 HIGHTECH DR
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City | TYLER
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State | TX
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Zip | 75703-2613
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Country | US
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Telephone | 903-300-0234
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Fax | 903-630-9999
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. TRACY CLEMONS
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Credential |
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Telephone | 903-300-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1059236
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License Number State | TX
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