Provider Demographics
NPI:1053514430
Name:PHYSICAL THERAPY OF GUN BARREL CITY, PLLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF GUN BARREL CITY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST IN CHARGE/CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:F
Authorized Official - Last Name:VALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-675-0077
Mailing Address - Street 1:PO BOX 2028
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751
Mailing Address - Country:US
Mailing Address - Phone:903-675-0077
Mailing Address - Fax:903-675-0078
Practice Address - Street 1:907 S. PALESTINE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751
Practice Address - Country:US
Practice Address - Phone:903-675-0077
Practice Address - Fax:903-675-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1019057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00133XMedicare PIN
TX00133XMedicare UPIN