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Organization
HASLAM THERAPY, INC.
Active
Organization
HASLAM THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN MARY THIBODEAUX HASLAM PT (OWNER)
(903) 297-0008
Entity
Organization
Contact information
Practice address
2010 GILMER RD, LONGVIEW, TX 75604-2511
(903) 297-0008
(903) 297-0018
Mailing address
2010 GILMER RD, LONGVIEW, TX 75604-2511
(903) 297-0008
(903) 297-0018
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1143816
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05322659198
STATE OF TEXAS CHARTER
TX
Enumeration date
09/30/2006
Last updated
08/22/2020
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