Provider Demographics
NPI:1568836732
Name:MEDICAL EXERCISE THERAPY
Entity Type:Organization
Organization Name:MEDICAL EXERCISE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:409-383-9521
Mailing Address - Street 1:212 NE WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4117
Mailing Address - Country:US
Mailing Address - Phone:409-383-9521
Mailing Address - Fax:817-642-5815
Practice Address - Street 1:212 NE WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4117
Practice Address - Country:US
Practice Address - Phone:409-383-9521
Practice Address - Fax:817-642-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty