Basic Information
| Provider Information | |||||||||
| NPI: | 1437580933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROESBECK THERAPY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1023 N. ELLIS | ||||||||
| Address2: | |||||||||
| City: | GROESBECK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547290323 | ||||||||
| FaxNumber: | 2547290328 | ||||||||
| Practice Location | |||||||||
| Address1: | 1023 N. ELLIS | ||||||||
| Address2: | |||||||||
| City: | GROESBECK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547290323 | ||||||||
| FaxNumber: | 2547290328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2013 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| AuthorizedOfficialLastName: | TROJACEK | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2547290323 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 1144632 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.