Organization
NACOGDOCHES PHYSICAL THERAPY LLC
Active
Other names
Nacogdoches Physical Exellence Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAX H MITCHELL PT (ADMINISTRATOR)
(936) 564-7780
Entity
Organization
Contact information
Practice address
3909 NE STALLING DRIVE, NACOGDOCHES, TX 75965
(936) 564-7780
(936) 564-0745
Mailing address
3909 NE STALLINGS DR, NACOGDOCHES, TX 75965-2169
(936) 564-7780
(936) 564-0745
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T24Y
BCBS TX
—
05
—
021252401
—
TX
Enumeration date
05/22/2006
Last updated
06/27/2011
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