Provider Demographics
NPI:1790890937
Name:PHYSICAL THERAPY ASSOCIATES, LP
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIESL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:806-792-5522
Mailing Address - Street 1:3223 S LOOP 289
Mailing Address - Street 2:STE 101
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-8312
Mailing Address - Country:US
Mailing Address - Phone:806-792-5522
Mailing Address - Fax:806-785-7582
Practice Address - Street 1:3223 S LOOP 289
Practice Address - Street 2:SUITE 101
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-8312
Practice Address - Country:US
Practice Address - Phone:806-792-5522
Practice Address - Fax:806-785-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653130000225100000X
TX555010000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168327801Medicaid
TX0133SMedicare ID - Type UnspecifiedGROUP NUMBER