Provider Demographics
NPI:1679022404
Name:TEXOMA REHAB PLLC
Entity type:Organization
Organization Name:TEXOMA REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CICALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-642-1926
Mailing Address - Street 1:PO BOX 4049
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0049
Mailing Address - Country:US
Mailing Address - Phone:940-642-1926
Mailing Address - Fax:940-569-9829
Practice Address - Street 1:2800 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7526
Practice Address - Country:US
Practice Address - Phone:972-612-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty