Provider Demographics
NPI:1023701471
Name:MERRITT MOBILE THERAPY, PLLC
Entity type:Organization
Organization Name:MERRITT MOBILE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-492-5215
Mailing Address - Street 1:15843 COUNTY ROAD 4191
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-7768
Mailing Address - Country:US
Mailing Address - Phone:903-492-5215
Mailing Address - Fax:
Practice Address - Street 1:15843 COUNTY ROAD 4191
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7768
Practice Address - Country:US
Practice Address - Phone:903-492-5215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty