1114286317 NPI number — JB THERAPY MASTER PLLC

Table of content: (NPI 1114286317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114286317 NPI number — JB THERAPY MASTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JB THERAPY MASTER 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:
Provider Other Organization Name Type Code:
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:
1114286317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25634 FARRIER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77406-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-463-1543
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25634 FARRIER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77406-1468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-463-1543
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
EILEEN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
832-463-1543

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  106947 , 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: 0084XL . This is a "BLUE CROSS BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB156742 . This is a "MEDICARE PART B" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 455423641 . This is a "TRICARE, HUMANA MILITARY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 798442 . This is a "OPTUM HEALTH, UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 304662501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30466250102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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