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General NPI Number Information
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NPI Number | 1992035562
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL PERFORMANCE ANALYSTS, L.P.
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 906 E FRONT ST
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City | TYLER
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State | TX
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Zip | 75702-8328
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Country | US
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Telephone | 903-920-5805
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Fax | 903-882-7421
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Provider Business Mailing Address
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Address Line | 211 CLUBVIEW DR
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City | HIDEAWAY
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State | TX
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Zip | 75771-5064
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Country | US
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Telephone | 903-920-5805
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Fax | 903-882-7421
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. BRANDON COBY MARROW
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Credential | P.T., M.P.T.
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Telephone | 903-920-5805
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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 | 1124584
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License Number State | TX
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