Provider Demographics
NPI:1396884177
Name:LIBERTY PHYSICAL THERAPY
Entity type:Organization
Organization Name:LIBERTY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:936-336-2241
Mailing Address - Street 1:PO BOX 9042
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-2742
Mailing Address - Country:US
Mailing Address - Phone:936-336-2241
Mailing Address - Fax:396-336-9083
Practice Address - Street 1:1200 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-5718
Practice Address - Country:US
Practice Address - Phone:936-336-2241
Practice Address - Fax:936-336-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
456810Medicare ID - Type Unspecified