Provider Demographics
NPI:1275841298
Name:MUSTANG THERAPIES, PLLC
Entity Type:Organization
Organization Name:MUSTANG THERAPIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:HALEY
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:936-348-9916
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-6688
Mailing Address - Country:US
Mailing Address - Phone:936-348-9916
Mailing Address - Fax:936-348-9936
Practice Address - Street 1:2703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2229
Practice Address - Country:US
Practice Address - Phone:936-348-9916
Practice Address - Fax:936-348-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty