Organization
CLEBURNE PHYSICAL THERAPY & SPORTS REHABILITATION, INC.
Active
Other names
Cleburne Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY ISMAIL (PRESIDENT)
(209) 353-1988
Entity
Organization
Contact information
Practice address
1014 N NOLAN RIVER RD, CLEBURNE, TX 76033-7925
(817) 641-8617
(817) 645-6966
Mailing address
1014 N NOLAN RIVER ROAD, CLEBURNE, TX 76033-7925
(817) 641-8617
(817) 645-6966
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6019700
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T67Y
BLUE CROSS BLUE SHIELD OF TEXAS
TX
05
—
087713602
—
TX
01
—
CB3646
RAILROAD PIN
TX
Enumeration date
02/13/2006
Last updated
12/06/2023
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