Provider Demographics
NPI:1205388832
Name:POLSTER DELONG MCKINNEY GROUP, LLC
Entity Type:Organization
Organization Name:POLSTER DELONG MCKINNEY GROUP, LLC
Other - Org Name:AMARILLO STRENGTH AND BALANCE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BRUGH
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, SCD
Authorized Official - Phone:806-676-5597
Mailing Address - Street 1:1911 PORT LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2470
Mailing Address - Country:US
Mailing Address - Phone:806-676-5597
Mailing Address - Fax:
Practice Address - Street 1:1911 PORT LN
Practice Address - Street 2:SUITE #1
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2470
Practice Address - Country:US
Practice Address - Phone:806-676-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy