Provider Demographics
NPI:1154718948
Name:PROSTEP AT AMARILLO
Entity type:Organization
Organization Name:PROSTEP AT AMARILLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA FMC
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-468-7611
Mailing Address - Street 1:5507 SW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5507 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4130
Practice Address - Country:US
Practice Address - Phone:806-468-7611
Practice Address - Fax:806-468-7603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PROGRESSIVE STEP CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)