Provider Demographics
NPI:1174550420
Name:COUCH PHYSICAL THERAPY AND REHABILITATION CENTER
Entity type:Organization
Organization Name:COUCH PHYSICAL THERAPY AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-572-3583
Mailing Address - Street 1:107 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2323
Mailing Address - Country:US
Mailing Address - Phone:903-572-3583
Mailing Address - Fax:903-572-8199
Practice Address - Street 1:107 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2323
Practice Address - Country:US
Practice Address - Phone:903-572-3583
Practice Address - Fax:903-572-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456667OtherOTHER
TX5958425OtherAETNA
TX650267OtherBLUE CROSS/BLUE SHIELD
TXPT1000396OtherWORKERS' COMPENSATION
TXPT1000396OtherWORKERS' COMPENSATION