Provider Demographics
NPI:1538125323
Name:PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-993-1173
Mailing Address - Street 1:4650 EVERHART RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2746
Mailing Address - Country:US
Mailing Address - Phone:361-993-1173
Mailing Address - Fax:361-994-1110
Practice Address - Street 1:4650 EVERHART RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2746
Practice Address - Country:US
Practice Address - Phone:361-993-1173
Practice Address - Fax:361-994-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR69314Medicare UPIN
TX650086Medicare ID - Type Unspecified