Provider Demographics
NPI:1417173584
Name:MASTERS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MASTERS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:SOFRIDES
Authorized Official - Last Name:VIET
Authorized Official - Suffix:
Authorized Official - Credentials:LPT, MTC
Authorized Official - Phone:936-634-3535
Mailing Address - Street 1:123 WESTCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-7357
Mailing Address - Country:US
Mailing Address - Phone:936-634-3535
Mailing Address - Fax:
Practice Address - Street 1:123 WESTCHESTER ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-7357
Practice Address - Country:US
Practice Address - Phone:936-634-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty