Provider Demographics
NPI:1770676199
Name:HASLAM THERAPY, INC.
Entity Type:Organization
Organization Name:HASLAM THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:THIBODEAUX HASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-297-0008
Mailing Address - Street 1:2010 GILMER RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2511
Mailing Address - Country:US
Mailing Address - Phone:903-297-0008
Mailing Address - Fax:903-297-0018
Practice Address - Street 1:2010 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2511
Practice Address - Country:US
Practice Address - Phone:903-297-0008
Practice Address - Fax:903-297-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1143816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX05322659198OtherSTATE OF TEXAS CHARTER