Provider Demographics
NPI:1891733838
Name:THERASPECIALISTS INC
Entity type:Organization
Organization Name:THERASPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:409-384-7041
Mailing Address - Street 1:296 MARVIN HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3479
Mailing Address - Country:US
Mailing Address - Phone:409-384-7041
Mailing Address - Fax:409-384-7064
Practice Address - Street 1:296 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-3479
Practice Address - Country:US
Practice Address - Phone:409-384-7041
Practice Address - Fax:409-384-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30KXOtherBLUE CROSS & BLUE SHIELD
TX00306WMedicare ID - Type Unspecified