Organization
9TH AVENUE PHYSICAL THERAPY, PLLC
Active
Other names
Park Plaza Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RENE SOAN MANUEL P.T. (OWNER)
(409) 466-7138
Entity
Organization
Contact information
Practice address
8333 9TH AVE., SUITE D, PORT ARTHUR, TX 77642
(409) 729-8111
(409) 729-8114
Mailing address
PO BOX 1488, GROVES, TX 77619-1488
(409) 466-7139
(409) 729-8114
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1047017
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3714404
CIGNA
TX
01
—
3960760
AETNA
TX
01
—
98ME
BCBS
TX
Enumeration date
11/28/2006
Last updated
08/14/2007
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