Provider Demographics
NPI:1720290315
Name:TEXOMA REHABILITAION & SPORTS MEDICINE CLINIC
Entity Type:Organization
Organization Name:TEXOMA REHABILITAION & SPORTS MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ROSSO
Authorized Official - Last Name:DELIGANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:903-892-9590
Mailing Address - Street 1:3409 POST OAK XING
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3492
Mailing Address - Country:US
Mailing Address - Phone:903-892-9590
Mailing Address - Fax:903-893-4449
Practice Address - Street 1:3409 POST OAK XING
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3492
Practice Address - Country:US
Practice Address - Phone:903-892-9590
Practice Address - Fax:903-893-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
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
TX00T69YOtherBCBS PROVIDER ID
TX80246TOtherBCBS PROVIDER ID