Provider Demographics
NPI:1932127818
Name:SDS PHYSICAL THERAPY LP
Entity Type:Organization
Organization Name:SDS PHYSICAL THERAPY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PFLUGHAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-732-8280
Mailing Address - Street 1:109 SHULT DR
Mailing Address - Street 2:# 206
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3009
Mailing Address - Country:US
Mailing Address - Phone:979-732-8280
Mailing Address - Fax:979-732-9740
Practice Address - Street 1:2122 HWY 71 SOUTH
Practice Address - Street 2:#103
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934
Practice Address - Country:US
Practice Address - Phone:979-732-8280
Practice Address - Fax:979-732-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX656400002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200385862OtherEIN
TX00189XMedicare UPIN
TX00189XMedicare PIN