Provider Demographics
NPI:1477090587
Name:TEXAS PHYSICAL THERAPY SPECIALISTS, PC
Entity Type:Organization
Organization Name:TEXAS PHYSICAL THERAPY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-590-4002
Mailing Address - Street 1:12508 JONES MALTSBERGER RD
Mailing Address - Street 2:110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4214
Mailing Address - Country:US
Mailing Address - Phone:888-590-4002
Mailing Address - Fax:210-590-4585
Practice Address - Street 1:960 GRUENE RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3919
Practice Address - Country:US
Practice Address - Phone:830-302-2340
Practice Address - Fax:830-302-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654940031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00372XMedicare PIN