Provider Demographics
NPI:1215428909
Name:EL PASO MANUAL PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:EL PASO MANUAL PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDAUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:915-503-1314
Mailing Address - Street 1:3900 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-6614
Mailing Address - Country:US
Mailing Address - Phone:915-329-6805
Mailing Address - Fax:915-255-3826
Practice Address - Street 1:2601 E YANDELL DR STE 232
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3724
Practice Address - Country:US
Practice Address - Phone:915-503-1314
Practice Address - Fax:915-255-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1207709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1207709OtherTEXAS PHYSICAL THERAPY LICENSE