Provider Demographics
NPI:1093379885
Name:PRACTICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRACTICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:915-300-0005
Mailing Address - Street 1:9611 ACER AVE.
Mailing Address - Street 2:BLDG B SUITE 114
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:915-300-0005
Mailing Address - Fax:915-300-0008
Practice Address - Street 1:9611 ACER AVE STE 114
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6719
Practice Address - Country:US
Practice Address - Phone:915-300-0005
Practice Address - Fax:915-300-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1160590OtherTDLR