Provider Demographics
NPI:1740299056
Name:TEXOMA PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:TEXOMA PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:LIRIO
Authorized Official - Last Name:LINZAG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-957-0385
Mailing Address - Street 1:301 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7349
Mailing Address - Country:US
Mailing Address - Phone:903-957-0385
Mailing Address - Fax:903-957-4006
Practice Address - Street 1:301 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7349
Practice Address - Country:US
Practice Address - Phone:903-957-0385
Practice Address - Fax:903-957-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649170000174400000X
TX549960000174400000X
TX1081404174400000X
TX1073286174400000X
TX108869174400000X
TX1074177174400000X
TX1020311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037JBOtherBCBS GOUP NUMBER
TX152780601Medicaid
TX0037JBOtherBCBS GOUP NUMBER
TX152780601Medicaid