Provider Demographics
NPI:1841204658
Name:EAST TEXAS THERAPY CENTERS, LLC
Entity Type:Organization
Organization Name:EAST TEXAS THERAPY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SQUIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-633-6901
Mailing Address - Street 1:4100 S MEDFORD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5622
Mailing Address - Country:US
Mailing Address - Phone:936-633-6901
Mailing Address - Fax:936-633-6084
Practice Address - Street 1:1900 NORTH WASHINGTON
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2105
Practice Address - Country:US
Practice Address - Phone:936-327-5748
Practice Address - Fax:936-327-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454845Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER