Provider Demographics
NPI:1205346541
Name:LAMESA PHYSICAL THERAPY AND SPORTS REHAB, PLLC
Entity type:Organization
Organization Name:LAMESA PHYSICAL THERAPY AND SPORTS REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:806-759-1483
Mailing Address - Street 1:706 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-2516
Mailing Address - Country:US
Mailing Address - Phone:806-759-1483
Mailing Address - Fax:806-370-6484
Practice Address - Street 1:221 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-5533
Practice Address - Country:US
Practice Address - Phone:806-759-1483
Practice Address - Fax:806-370-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-30
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1262686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty