Organization
9TH AVENUE PHYSICAL THERAPY, PLLC
Active
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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