Provider Demographics
NPI:1841898137
Name:PINEYWOODS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PINEYWOODS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:936-645-3348
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-0979
Mailing Address - Country:US
Mailing Address - Phone:936-645-3348
Mailing Address - Fax:
Practice Address - Street 1:1400 WEST 6TH STREET
Practice Address - Street 2:SUITE 6 AND 7
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785
Practice Address - Country:US
Practice Address - Phone:936-645-3348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy