Provider Demographics
NPI:1417117847
Name:SHAMROCK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHAMROCK PHYSICAL THERAPY
Other - Org Name:REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-293-5532
Mailing Address - Street 1:1611 FM 318 E
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-6705
Mailing Address - Country:US
Mailing Address - Phone:361-293-5532
Mailing Address - Fax:800-934-8051
Practice Address - Street 1:1611 FM 318 E
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-6705
Practice Address - Country:US
Practice Address - Phone:361-293-5532
Practice Address - Fax:800-834-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601940022261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456609Medicare PIN