Individual
KENNETH SHANE HALCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2875 LEWIS LANE, SUITE B, PARIS, TX 75460-9331
(903) 785-3861
(903) 739-8768
Mailing address
2875 LEWIS LANE, SUITE B, PARIS, TX 75460-9331
(903) 785-3861
(903) 739-8768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1090686
TX
225100000X
Physical Therapist
2635
OK
2251S0007X
Sports Physical Therapist
2635
OK
2251X0800X
Orthopedic Physical Therapist
Primary
2635
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120499
SUPERIOR PROVIDER NUMBER
—
01
—
5197152
AETNA PROVIDER NUMBER
—
01
—
80813T
BCBS PROVIDER NUMBER
TX
Enumeration date
06/08/2006
Last updated
04/14/2008
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