Provider Demographics
NPI:1326779323
Name:LONESTAR PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Entity Type:Organization
Organization Name:LONESTAR PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SWYGERT
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CSCS
Authorized Official - Phone:903-274-9977
Mailing Address - Street 1:5759 EAGLES NEST BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6231
Mailing Address - Country:US
Mailing Address - Phone:903-405-4899
Mailing Address - Fax:903-638-2741
Practice Address - Street 1:5759 EAGLES NEST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6231
Practice Address - Country:US
Practice Address - Phone:903-405-4899
Practice Address - Fax:903-638-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty