NPIMap

Organization Active NPI

East Texas Physical Therapy

  • Physical Therapist
  • Sulphur Springs, TX
National Provider Identifier
1629356787
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1146716 Issued in TX
Legal business name
EAST TEXAS PHYSICAL THERAPY
Practice address
1501 Holiday Dr
Sulphur Springs, TX 75482-4707
Phone
(903) 335-8727
Fax
(903) 335-8217
NPI assigned
Jul 23, 2011
Last updated
Nov 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

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

Authorized official

Name
Salli McClendon
Title
Office Manager
Phone
(214) 477-0141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1146716 TX Primary

Addresses

Primary practice location

1501 Holiday Dr
Sulphur Springs, TX 75482-4707

Mailing address

PO Box 596
Sulphur Springs, TX 75483-0596

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200130000185 TX Part B Supplier - Clinic/Group Practice 8729237904 Receives reassigned benefits from 10 practitioners
Practice locations: Sulphur Springs, TX

National Provider Directory

National Provider Directory

Locations

1501 Holiday Dr
Sulphur Springs, TX 75482
Phone (903) 335-8727

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1311379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1629356787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 596",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754830596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 HOLIDAY DR",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754824707",
            "telephone_number": "903-335-8727",
            "fax_number": "903-335-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-23",
        "last_updated": "2012-11-27",
        "status": "A",
        "authorized_official_last_name": "MCCLENDON",
        "authorized_official_first_name": "SALLI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "214-477-0141"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1146716",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sulphur Springs, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.