Provider Demographics
NPI:1225008907
Name:GIDDINGS PHYSICAL THERAPY CLINIC, INC
Entity Type:Organization
Organization Name:GIDDINGS PHYSICAL THERAPY CLINIC, INC
Other - Org Name:ELGIN PHYSICAL THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOSA-CORTINAS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:512-285-4406
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-0961
Mailing Address - Country:US
Mailing Address - Phone:512-285-4406
Mailing Address - Fax:512-285-2030
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-1628
Practice Address - Country:US
Practice Address - Phone:512-285-4406
Practice Address - Fax:512-285-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168637001Medicaid
TX2657352OtherAETNA
TX8T0982OtherBLUE CROSS BLUE SHIELD
TX2657352OtherAETNA