Provider Demographics
NPI:1376827386
Name:CROSSROADS PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:CROSSROADS PHYSICAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.P.T./OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:361-572-9113
Mailing Address - Street 1:1501 N NAVARRO ST # C
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6027
Mailing Address - Country:US
Mailing Address - Phone:361-572-9113
Mailing Address - Fax:361-572-9195
Practice Address - Street 1:1501 N NAVARRO ST # C
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6027
Practice Address - Country:US
Practice Address - Phone:361-572-9113
Practice Address - Fax:361-572-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty