Provider Demographics
NPI:1053651935
Name:TEXAS PHYSICAL THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:TEXAS PHYSICAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-590-4002
Mailing Address - Street 1:17325 BELL NORTH DR
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3368
Mailing Address - Country:US
Mailing Address - Phone:888-590-4002
Mailing Address - Fax:210-590-4585
Practice Address - Street 1:11909 PRESTON RD
Practice Address - Street 2:SUITE 1482
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2746
Practice Address - Country:US
Practice Address - Phone:888-590-4002
Practice Address - Fax:210-590-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170506301Medicaid
TX00372XMedicare PIN