Provider Demographics
NPI:1235353350
Name:PHYSICAL THERAPY AND REHAB CONCEPTS, P.C.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND REHAB CONCEPTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER, PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELESA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:512-353-4575
Mailing Address - Street 1:915 HIGHWAY 80
Mailing Address - Street 2:SAN MAR PLAZA SHOPPING CENTER
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8115
Mailing Address - Country:US
Mailing Address - Phone:512-353-4575
Mailing Address - Fax:512-353-4580
Practice Address - Street 1:915 HIGHWAY 80
Practice Address - Street 2:SAN MAR PLAZA SHOPPING CENTER
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-8115
Practice Address - Country:US
Practice Address - Phone:512-353-4575
Practice Address - Fax:512-353-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8995B6Medicare ID - Type UnspecifiedDUANE WIEDING
TX8997B6Medicare ID - Type UnspecifiedKIRK PAINTER
TX8996B6Medicare ID - Type UnspecifiedVIKKI HILL
TX8999B6Medicare ID - Type UnspecifiedMELESA YAGER