Provider Demographics
NPI:1225380025
Name:TEXAS PHYSICAL THERAPY SPECIALISTS - JOURDANTON
Entity Type:Organization
Organization Name:TEXAS PHYSICAL THERAPY SPECIALISTS - JOURDANTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
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:
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGHWAY 97 E
Practice Address - Street 2:SUITE A
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1602
Practice Address - Country:US
Practice Address - Phone:830-769-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
654940008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty