Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 225100000X | Physical Therapist | | 1082881 | TEXAS | No |
| 2 | 261QP2000X | Clinic/Center | Physical Therapy | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1766347 01 | MEDICAID | TEXAS | |
| 2 | 721311 | OTHER | TEXAS | ALIGN NETWORKS |
| 3 | 721311 | OTHER | TEXAS | EVERCARE MP PROGRAM |
| 4 | 48KM | OTHER | TEXAS | BCBS GROUP |
| 5 | 8F24409 | OTHER | | MEDICARE INDIVIDUAL PTAN |
| 6 | OA6219 | OTHER | TEXAS | MEDICARE GROUP PTAN |
| 7 | 721311 | OTHER | TEXAS | UNITED MEDICAL RESOURCES |
| 8 | 721311 | OTHER | TEXAS | UNIVERSAL SMARTCOMP WORKERS' COMPENSATION |
| 9 | 721311 | OTHER | TEXAS | TRICARE |
| 10 | 721311 | OTHER | TEXAS | MEDRISK WORKERS' COMPENSATION |
| 11 | 721311 | OTHER | TEXAS | WORKERS COMPENSATION NETWORK FOR INTEGRATED HEALTH PLAN |
| 12 | 721311 | OTHER | TEXAS | TEXAS STAR-PLUS |
| 13 | 721311 | OTHER | TEXAS | CYPRESSCARE WORKERS COMPENSATION |
| 14 | 8T1541 | OTHER | TEXAS | BCBS INDIVIDUAL |
| 15 | 721311 | OTHER | TEXAS | UNITED HEALTHCARE |
| 16 | 721311 | OTHER | TEXAS | WORKERS COMPENSATION NETWORK FOR HEALTH SYSTEMS INTERNATIONAL |
| 17 | 721311 | OTHER | | WORKERS COMPENSATION NETWORK FOR ROCKPORT HEALTHCARE GROUP |
| 18 | 721311 | OTHER | TEXAS | RESERVE NATIONAL INSURANCE COMPANY |