Provider Demographics
NPI:1326234071
Name:ABILENE PHYSICAL THERAPY AND SPORTS REHAB CLINIC, INC.
Entity Type:Organization
Organization Name:ABILENE PHYSICAL THERAPY AND SPORTS REHAB CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM (BILL)
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEEBLE
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:325-695-6011
Mailing Address - Street 1:4127 S DANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-7230
Mailing Address - Country:US
Mailing Address - Phone:325-695-6011
Mailing Address - Fax:325-695-4947
Practice Address - Street 1:4127 S DANVILLE DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-7230
Practice Address - Country:US
Practice Address - Phone:325-695-6011
Practice Address - Fax:325-695-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-2353-9225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00939EMedicare PIN