Provider Demographics
NPI:1578979183
Name:TRI-PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:TRI-PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:SALINAS
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT, OCS, FAAOMPT
Authorized Official - Phone:432-614-1987
Mailing Address - Street 1:4555 E UNIVERSITY BLVD STE C7
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-8137
Mailing Address - Country:US
Mailing Address - Phone:432-557-5267
Mailing Address - Fax:
Practice Address - Street 1:4555 E UNIVERSITY BLVD STE C7
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-8137
Practice Address - Country:US
Practice Address - Phone:432-557-5267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167253261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750522108Medicare PIN