MEDICARE: FUNCTIONAL PERFORMANCE ANALYSTS, L.P.

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	261QP2000X	Physical Therapy Clinic/Center	1124584	TX

General Provider Information

NPI Number	:	1992035562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL PERFORMANCE ANALYSTS, L.P.

Provider Business Mailing Address
First Line	:	211 CLUBVIEW DR
Second Line	:
City	:	HIDEAWAY
State	:	TX
Zip	:	75771-5064
Country	:	US
Telephone Number	:	903-920-5805
Fax Number	:	903-882-7421

Provider Business Practice Location Address
First Line	:	906 E FRONT ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8328
Country	:	US
Telephone Number	:	903-920-5805
Fax Number	:	903-882-7421

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. BRANDON COBY MARROW
Credential	:	P.T., M.P.T.
Telephone Number	:	903-920-5805

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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