Provider Demographics
NPI:1023195203
Name:WISE PERFORMANCE PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:WISE PERFORMANCE PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1208 S FM 51
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-2408
Mailing Address - Country:US
Mailing Address - Phone:940-627-7554
Mailing Address - Fax:940-327-7582
Practice Address - Street 1:1208 S FM 51
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-2408
Practice Address - Country:US
Practice Address - Phone:940-627-7554
Practice Address - Fax:940-627-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676577Medicare Oscar/Certification