Provider Demographics
NPI:1487906020
Name:TEXAS PHYSICAL THERAPY SPECIALISTS
Entity type:Organization
Organization Name:TEXAS PHYSICAL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-590-4002
Mailing Address - Street 1:1700 E PALM VALLEY BLVD
Mailing Address - Street 2:SUITE 395
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4683
Mailing Address - Country:US
Mailing Address - Phone:512-354-4067
Mailing Address - Fax:512-354-4068
Practice Address - Street 1:1700 E PALM VALLEY BLVD
Practice Address - Street 2:SUITE 395
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4683
Practice Address - Country:US
Practice Address - Phone:512-354-4067
Practice Address - Fax:512-354-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620940005261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy