MEDICARE: COUCH PHYSICAL THERAPY AND REHABILITATION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	456667	OTHER	TX	OTHER
2	5958425	OTHER	TX	AETNA
3	650267	OTHER	TX	BLUE CROSS/BLUE SHIELD
4	PT1000396	OTHER	TX	WORKERS' COMPENSATION

General Provider Information

NPI Number	:	1174550420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUCH PHYSICAL THERAPY AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	107 W 20TH ST
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2323
Country	:	US
Telephone Number	:	903-572-3583
Fax Number	:	903-572-8199

Provider Business Practice Location Address
First Line	:	107 W 20TH ST
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2323
Country	:	US
Telephone Number	:	903-572-3583
Fax Number	:	903-572-8199

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	RONALD LLOYD COUCH
Credential	:	P.T.
Telephone Number	:	903-572-3583

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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Directions to “COUCH PHYSICAL THERAPY AND REHABILITATION CENTER ” Practice Location

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