Provider Demographics
NPI:1336147545
Name:BUTLER SHAHAN PHYSICAL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:BUTLER SHAHAN PHYSICAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER/
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-892-1333
Mailing Address - Street 1:19325 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6885
Mailing Address - Country:US
Mailing Address - Phone:903-892-1333
Mailing Address - Fax:903-893-9943
Practice Address - Street 1:19325 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6885
Practice Address - Country:US
Practice Address - Phone:903-892-1333
Practice Address - Fax:903-893-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632540000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0813081-01Medicaid
TX00879EMedicare ID - Type Unspecified