Provider Demographics
NPI:1770888406
Name:LIBERTY VENTURE GROUP, LLC
Entity type:Organization
Organization Name:LIBERTY VENTURE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-679-7034
Mailing Address - Street 1:6014 45TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3772
Mailing Address - Country:US
Mailing Address - Phone:806-780-7433
Mailing Address - Fax:806-780-7434
Practice Address - Street 1:6014 45TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3772
Practice Address - Country:US
Practice Address - Phone:806-780-7433
Practice Address - Fax:806-780-7434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2070918225100000X
TX2018420225200000X
TX1061984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB125067Medicare PIN