Provider Demographics
NPI:1679604078
Name:PHYSICAL THERAPY UNLIMITED, P.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY UNLIMITED, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENY OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:830-907-2145
Mailing Address - Street 1:1356 FM 2673
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-4510
Mailing Address - Country:US
Mailing Address - Phone:830-907-2145
Mailing Address - Fax:830-964-2373
Practice Address - Street 1:1356 FM 2673
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-4510
Practice Address - Country:US
Practice Address - Phone:830-907-2145
Practice Address - Fax:830-964-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX603080000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0876609-01Medicaid
TX603080000OtherFACILITY STATE LICENSE
TX603080000OtherFACILITY STATE LICENSE
TX=========OtherTAX ID NUMBER