Provider Demographics
NPI:1003153438
Name:PLANET REHAB THERAPY SOLUTIONS
Entity Type:Organization
Organization Name:PLANET REHAB THERAPY SOLUTIONS
Other - Org Name:PLANET REHAB THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:I
Authorized Official - Credentials:COTA
Authorized Official - Phone:903-483-7227
Mailing Address - Street 1:5907 W MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6011
Mailing Address - Country:US
Mailing Address - Phone:903-483-7227
Mailing Address - Fax:903-483-7227
Practice Address - Street 1:5907 W MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6011
Practice Address - Country:US
Practice Address - Phone:903-483-7227
Practice Address - Fax:903-483-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2017-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty