Provider Demographics
NPI:1699716076
Name:FREEDOM PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST ASST.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:817-326-1375
Mailing Address - Street 1:5310 ACTON HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-2948
Mailing Address - Country:US
Mailing Address - Phone:817-326-1375
Mailing Address - Fax:
Practice Address - Street 1:5310 ACTON HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-2948
Practice Address - Country:US
Practice Address - Phone:817-326-1375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W497Medicare ID - Type Unspecified