Provider Demographics
NPI:1417240771
Name:ROCKY MOUNTAIN THERAPY SERVICES TEXAS LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN THERAPY SERVICES TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WORTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-417-5017
Mailing Address - Street 1:1514 N GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3029
Mailing Address - Country:US
Mailing Address - Phone:432-550-8777
Mailing Address - Fax:432-550-8333
Practice Address - Street 1:1514 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3029
Practice Address - Country:US
Practice Address - Phone:432-550-8777
Practice Address - Fax:432-550-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty