Provider Demographics
NPI:1043452857
Name:TEXOMA PHYSICAL THERAPY & REHABILITATION CLINIC, LLC
Entity Type:Organization
Organization Name:TEXOMA PHYSICAL THERAPY & REHABILITATION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-371-6191
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-0820
Mailing Address - Country:US
Mailing Address - Phone:580-371-2334
Mailing Address - Fax:580-371-2351
Practice Address - Street 1:101 WEST MAIN
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460
Practice Address - Country:US
Practice Address - Phone:580-371-2334
Practice Address - Fax:580-371-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty