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Organization
OBACH PHYSICAL THERAPY CLINIC LLC
Active
Organization
OBACH PHYSICAL THERAPY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY CLEMONS (OFFICE MANAGER)
(903) 300-0234
Entity
Organization
Contact information
Practice address
200 COUNTY ROAD 3801, BULLARD, TX 75757
(903) 894-4633
(903) 894-4648
Mailing address
4882 HIGHTECH DR, TYLER, TX 75703-2613
(903) 300-0234
(903) 630-9999
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1059236
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1059236
LICENSE NO.
TX
01
—
1063700110
NPI
TX
01
—
TXB134151
MEDICARE NO.
TX
Enumeration date
02/06/2015
Last updated
11/15/2022
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