Basic Information
| Provider Information | |||||||||
| NPI: | 1164525291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS PHYSICAL THERAPY SPECIALISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8335 AGORA PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SELMA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106588483 | ||||||||
| FaxNumber: | 2106580828 | ||||||||
| Practice Location | |||||||||
| Address1: | 8335 AGORA PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SELMA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106588483 | ||||||||
| FaxNumber: | 2106580828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 12/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8306257310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.