Provider Demographics
NPI:1124783311
Name:THE ROCK PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:THE ROCK PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:HOGUE
Authorized Official - Last Name:TOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-517-4612
Mailing Address - Street 1:3360 NE LOOP 286 STE 101
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-3438
Mailing Address - Country:US
Mailing Address - Phone:903-669-3535
Mailing Address - Fax:
Practice Address - Street 1:3360 NE LOOP 286 STE 101
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3438
Practice Address - Country:US
Practice Address - Phone:903-669-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1133932OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS
TX870713Medicaid