Provider Demographics
NPI:1790457356
Name:SOUTH TEXAS MOBILE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SOUTH TEXAS MOBILE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:505-220-7864
Mailing Address - Street 1:4501 OCASEY DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3122
Mailing Address - Country:US
Mailing Address - Phone:505-220-7864
Mailing Address - Fax:
Practice Address - Street 1:4501 OCASEY DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3122
Practice Address - Country:US
Practice Address - Phone:505-220-7864
Practice Address - Fax:361-356-4391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEN STX ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty