Provider Demographics
NPI:1508071101
Name:VICTORY PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:VICTORY PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1011 E ENNIS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 E ENNIS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4351
Practice Address - Country:US
Practice Address - Phone:972-878-0503
Practice Address - Fax:972-878-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5821670001Medicare NSC