1407914872 NPI number — THERAPY SPOT PLLC

Table of content: (NPI 1407914872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407914872 NPI number — THERAPY SPOT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY SPOT PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE THERAPY SPOT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407914872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8619 BROADWAY ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-8496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-485-4818
Provider Business Mailing Address Fax Number:
281-485-5446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8619 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-8496
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-485-4818
Provider Business Practice Location Address Fax Number:
281-485-5446
Provider Enumeration Date:
12/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GERKE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CIO
Authorized Official Telephone Number:
713-383-9700

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 164781001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3435197 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".