Provider Demographics
NPI:1790744522
Name:RG2 P C
Entity Type:Organization
Organization Name:RG2 P C
Other - Org Name:WEST TEXAS THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:432-570-7850
Mailing Address - Street 1:PO BOX 80700
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-0700
Mailing Address - Country:US
Mailing Address - Phone:432-570-7850
Mailing Address - Fax:432-520-2528
Practice Address - Street 1:4304 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-4824
Practice Address - Country:US
Practice Address - Phone:432-570-7850
Practice Address - Fax:432-520-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA3625Medicare UPIN