Provider Demographics
NPI:1801935838
Name:AFFILIATED THERAPY GROUP PRACTICE, INC.
Entity type:Organization
Organization Name:AFFILIATED THERAPY GROUP PRACTICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHAUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:361-853-6100
Mailing Address - Street 1:4738 SOUTH PADRE ISLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-853-6100
Mailing Address - Fax:361-853-6106
Practice Address - Street 1:4738 SOUTH PADRE ISLAND DRIVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-853-6100
Practice Address - Fax:361-853-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1824625Medicaid
TX1730199613Medicare ID - Type UnspecifiedGROUP NPI NUMBER
TX1824625Medicaid