Provider Demographics
NPI:1972267888
Name:CREEL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CREEL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CERT DN
Authorized Official - Phone:936-305-3354
Mailing Address - Street 1:PO BOX 632351
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2351
Mailing Address - Country:US
Mailing Address - Phone:936-305-3354
Mailing Address - Fax:936-305-3990
Practice Address - Street 1:4635 NE STALLINGS DR STE 104
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1667
Practice Address - Country:US
Practice Address - Phone:936-556-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy