Provider Demographics
NPI:1376204735
Name:PATHWAY REHABILITATION LLC
Entity Type:Organization
Organization Name:PATHWAY REHABILITATION LLC
Other - Org Name:TOLAR SPORTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:254-485-1482
Mailing Address - Street 1:582 S SUGARTREE DR
Mailing Address - Street 2:
Mailing Address - City:LIPAN
Mailing Address - State:TX
Mailing Address - Zip Code:76462-4341
Mailing Address - Country:US
Mailing Address - Phone:254-485-1482
Mailing Address - Fax:
Practice Address - Street 1:1140 FM 1189 STE 115
Practice Address - Street 2:
Practice Address - City:MILLSAP
Practice Address - State:TX
Practice Address - Zip Code:76066-3540
Practice Address - Country:US
Practice Address - Phone:254-485-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01Other01