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NPI Code Detail

MEDICARE: EAST TEXAS PHYSICAL THERAPY

MEDICARE: EAST TEXAS PHYSICAL THERAPY
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
1225100000XPhysical Therapist1146716TX

General Provider Information

NPI Number : 1629356787
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TEXAS PHYSICAL THERAPY
Provider Business Mailing Address
First Line : PO BOX 596
Second Line :
City : SULPHUR SPRINGS
State : TX
Zip : 75483-0596
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1501 HOLIDAY DR
Second Line :
City : SULPHUR SPRINGS
State : TX
Zip : 75482-4707
Country : US
Telephone Number : 903-335-8727
Fax Number : 903-335-8217
Authorized Official
Title or Position : OFFICE MANAGER
Name : SALLI MCCLENDON
Credential :
Telephone Number : 214-477-0141
Provider Enumeration Date : 07/23/2011
Last Update Date : 11/27/2012

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Practice Location Address:
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Directions to “EAST TEXAS PHYSICAL THERAPY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.