Organization
IMPACT PHYSICAL THERAPY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN SPANIHEL P.T. (OWNER)
(956) 689-9195
Entity
Organization
Contact information
Practice address
100 N. HWY 77, SUITE N, RAYMONDVILLE, TX 78580-4010
(956) 689-9195
(956) 659-9217
Mailing address
100 N. HWY 77, SUITE N, RAYMONDVILLE, TX 78580-4010
(956) 689-9195
(956) 659-9217
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1056786
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021737401
—
TX
05
—
021737402
—
TX
05
—
107970903
—
TX
01
—
116160
SUPERIOR HEALTHPLAN
TX
01
—
659445
BCBS
TX
Enumeration date
12/20/2006
Last updated
04/17/2012
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