1902816457 NPI number — HOUSTON AQUATIC THERAPY INSTITUTE, INC.

Table of content: (NPI 1902816457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902816457 NPI number — HOUSTON AQUATIC THERAPY INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSTON AQUATIC THERAPY INSTITUTE, INC.
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:
TEXAS ORTHOPAEDIC AND AQUATIC THERAPY INSTITUTE
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:
1902816457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4710 KATY FREEWAY, SUITE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77007-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-695-7800
Provider Business Mailing Address Fax Number:
713-695-7806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4710 KATY FREEWAY, SUITE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77007-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-695-7800
Provider Business Practice Location Address Fax Number:
713-695-7806
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
LYNETTE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
713-695-7800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  1081297 , 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: 65044000 . This is a "TEXAS BOARD OF PT EXAMINE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1070712 . This is a "PHYSICAL THERAPIST LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".