Provider Demographics
NPI:1508949132
Name:MCADA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MCADA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:MCADA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:830-583-9912
Mailing Address - Street 1:408 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-2706
Mailing Address - Country:US
Mailing Address - Phone:830-583-9912
Mailing Address - Fax:830-583-9878
Practice Address - Street 1:408 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-2706
Practice Address - Country:US
Practice Address - Phone:830-583-9912
Practice Address - Fax:830-583-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456727Medicare ID - Type Unspecified