Provider Demographics
NPI:1720213911
Name:TEXS PHYSICAL THERAPY A CALIFORNIA
Entity Type:Organization
Organization Name:TEXS PHYSICAL THERAPY A CALIFORNIA
Other - Org Name:BODY&BALANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEIXEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-541-8005
Mailing Address - Street 1:1248 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3104
Mailing Address - Country:US
Mailing Address - Phone:805-541-8005
Mailing Address - Fax:805-541-8010
Practice Address - Street 1:1248 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3104
Practice Address - Country:US
Practice Address - Phone:805-541-8005
Practice Address - Fax:805-541-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 18625261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT18625Medicare PIN