Provider Demographics
NPI:1356435028
Name:FREE, PAUL BRIAN (MPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BRIAN
Last Name:FREE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 80744
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-0744
Mailing Address - Country:US
Mailing Address - Phone:432-664-9392
Mailing Address - Fax:432-689-2732
Practice Address - Street 1:2215 N MIDLAND DRIVE
Practice Address - Street 2:STE 4A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:432-697-6677
Practice Address - Fax:432-697-6678
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C6290Medicare PIN