Provider Demographics
NPI:1295868438
Name:TEXOMA REHABILITATION & SPORTS MEDICINE CLINIC
Entity Type:Organization
Organization Name:TEXOMA REHABILITATION & SPORTS MEDICINE CLINIC
Other - Org Name:PAT DELIGANS, PT TEXOMA REHABILITATION & SPORTS MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERRAPIST OWNER PTR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:ROSSO
Authorized Official - Last Name:DELIGANS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-892-9590
Mailing Address - Street 1:3409 POST OAK XING
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3492
Mailing Address - Country:US
Mailing Address - Phone:903-892-9590
Mailing Address - Fax:903-893-4449
Practice Address - Street 1:3409 POST OAK XING
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3492
Practice Address - Country:US
Practice Address - Phone:903-892-9590
Practice Address - Fax:903-893-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60504000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4427186OtherAETNA PIN