NPIMap

Organization Active NPI

Obach Physical Therapy Clinic LLC

  • Physical Therapist
  • Bullard, TX
National Provider Identifier
1912398348
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1059236 Issued in TX
Legal business name
OBACH PHYSICAL THERAPY CLINIC LLC
Practice address
200 County Road 3801
Bullard, TX 75757
Phone
(903) 894-4633
Fax
(903) 894-4648
NPI assigned
Feb 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Authorized official

Name
Ms. Tracy Clemons
Title
Office Manager
Phone
(903) 300-0234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 1059236 TX Primary

Addresses

Primary practice location

200 County Road 3801
Bullard, TX 75757

Mailing address

4882 Hightech Dr
Tyler, TX 75703-2613
Phone (903) 300-0234

Other practice location 1

4882 Hightech Dr
Tyler, TX 75703-2613
Phone (903) 300-0234

Other identifiers 3

IdentifierTypeStateIssuer
1059236OtherTXLICENSE NO.
1063700110OtherTXNPI
TXB134151OtherTXMEDICARE NO.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150421002017 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3375861420 Receives reassigned benefits from 4 practitioners
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

200 County Road 3801
Bullard, TX 75757
Phone (903) 243-0421

4882 Hightech Dr
Tyler, TX 75703
Phone (903) 300-0234

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1423180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668470400000",
    "number": "1912398348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4882 HIGHTECH DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032613",
            "telephone_number": "903-300-0234",
            "fax_number": "903-630-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 COUNTY ROAD 3801",
            "city": "BULLARD",
            "state": "TX",
            "postal_code": "75757",
            "telephone_number": "903-894-4633",
            "fax_number": "903-894-4648"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4882 Hightech Dr",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757032613",
            "country_code": "US",
            "telephone_number": "903-300-0234",
            "fax_number": "903-630-9999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OBACH PHYSICAL THERAPY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-06",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A",
        "authorized_official_last_name": "CLEMONS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "903-300-0234",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1059236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NO.",
            "identifier": "1059236",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1063700110",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NO.",
            "identifier": "TXB134151",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bullard, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.