Provider Demographics
NPI:1841200524
Name:PANHANDLE SPORTS MEDICINE INSTITUTE, PA
Entity Type:Organization
Organization Name:PANHANDLE SPORTS MEDICINE INSTITUTE, PA
Other - Org Name:ZACH THOMAS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:806-355-5244
Mailing Address - Street 1:6022 W 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7504
Mailing Address - Country:US
Mailing Address - Phone:806-355-5244
Mailing Address - Fax:806-353-6151
Practice Address - Street 1:6022 W 48TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7504
Practice Address - Country:US
Practice Address - Phone:806-355-5244
Practice Address - Fax:806-353-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652790000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096KMOtherBCBSTX