Provider Demographics
NPI:1568488179
Name:PHYSICAL THERAPY CLINIC OF PARIS LP
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CLINIC OF PARIS LP
Other - Org Name:PHYSICAL THERAPY CLINIC OF PARIS-HUGO
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-785-3861
Mailing Address - Street 1:2875 LEWIS LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9331
Mailing Address - Country:US
Mailing Address - Phone:903-785-3861
Mailing Address - Fax:
Practice Address - Street 1:1601 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4238
Practice Address - Country:US
Practice Address - Phone:580-326-0036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK376594Medicare Oscar/Certification