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Organization
EAST TEXAS TREATMENT CENTER
Active
Organization
EAST TEXAS TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY HARDAN (EXECUTIVE DIRECTOR)
(903) 984-5571
Entity
Organization
Contact information
Practice address
1200 DUDLEY RD, KILGORE, TX 75662-3306
(903) 984-5571
(903) 984-1913
Mailing address
1200 DUDLEY RD, KILGORE, TX 75662-3306
(903) 984-5571
(903) 984-1913
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
605680000
TX
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
TX
Other
Enumeration date
08/31/2005
Last updated
02/17/2022
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