East Texas Performance Rehabilitation Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1033462 Issued in TX

Legal business name

EAST TEXAS PERFORMANCE REHABILITATION INC

Practice address

434 East Loop 281
Suite 103
Longview, TX 75605

Phone

(903) 247-3422

Fax

(903) 247-3424

NPI assigned

Sep 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Andree Sibille Reynolds, PHYSICAL THEREPISTNPI 1982774436

Title

PT Owner

Phone

(903) 247-3244

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andree Sibille Reynolds, PHYSICAL THERAPIST

  • Physical Therapist
  • Longview, TX
  • NPI 1982774436
  NPD (past) Authorized official
• Charles Lee Reynolds, MED, ATC, LAT

  • Athletic Trainer
  • Longview, TX
  • NPI 1457565533
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208390400000",
    "number": "1205928561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 EAST LOOP 281",
            "address_2": "SUITE 103",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-247-3422",
            "fax_number": "903-247-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 EAST LOOP 281",
            "address_2": "SUITE 103",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-247-3422",
            "fax_number": "903-247-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PERFORMANCE REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-04-17",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "ANDREE",
        "authorized_official_middle_name": "SIBILLE",
        "authorized_official_title_or_position": "PT OWNER",
        "authorized_official_telephone_number": "903-247-3244",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PHYSICAL THEREPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1033462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Longview, TX
• Providers in Longview, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.