Provider Demographics
NPI:1023288693
Name:REHAB AND PHYSICAL THERAPY SPECIALISTS OF BMT
Entity type:Organization
Organization Name:REHAB AND PHYSICAL THERAPY SPECIALISTS OF BMT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:409-899-5900
Mailing Address - Street 1:4374 DOWLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-899-5900
Mailing Address - Fax:409-899-5901
Practice Address - Street 1:4374 DOWLEN ROAD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-899-5900
Practice Address - Fax:409-899-5901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHAB AND PHYSICAL THERAPY SPECIALISTS OF BMT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID
TX00586ZMedicare PIN