Provider Demographics
NPI:1831491760
Name:ALTA MESA PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ALTA MESA PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:915-544-4100
Mailing Address - Street 1:615 E SCHUSTER AVE
Mailing Address - Street 2:SUITE 9A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4350
Mailing Address - Country:US
Mailing Address - Phone:915-544-4100
Mailing Address - Fax:915-544-4102
Practice Address - Street 1:615 E SCHUSTER AVE
Practice Address - Street 2:SUITE 9A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4350
Practice Address - Country:US
Practice Address - Phone:915-544-4100
Practice Address - Fax:915-544-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2885147-01Medicaid
TXB129022OtherMEDICARE