Provider Demographics
NPI:1326059346
Name:PROFESSIONAL PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPY SERVICES LLC
Other - Org Name:ADVANCED HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:MISS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-353-6544
Mailing Address - Street 1:940 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4309
Mailing Address - Country:US
Mailing Address - Phone:806-358-7474
Mailing Address - Fax:806-358-7575
Practice Address - Street 1:940 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4309
Practice Address - Country:US
Practice Address - Phone:806-358-7474
Practice Address - Fax:806-355-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657350000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650472Medicare ID - Type Unspecified