Provider Demographics
NPI:1164525291
Name:TEXAS PHYSICAL THERAPY SPECIALISTS PC
Entity Type:Organization
Organization Name:TEXAS PHYSICAL THERAPY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:830-625-7310
Mailing Address - Street 1:8335 AGORA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1316
Mailing Address - Country:US
Mailing Address - Phone:210-658-8483
Mailing Address - Fax:210-658-0828
Practice Address - Street 1:8335 AGORA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1316
Practice Address - Country:US
Practice Address - Phone:210-658-8483
Practice Address - Fax:210-658-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00372XMedicare PIN