1629613450 NPI number — PHYSIOBABY PHYSICAL THERAPY & WELLNESS, LLC

Table of content: (NPI 1629613450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629613450 NPI number — PHYSIOBABY PHYSICAL THERAPY & WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOBABY PHYSICAL THERAPY & WELLNESS, LLC
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:
PHYSIOBABY THERAPY & WELLNESS, LLC
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:
1629613450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5900 BALCONES DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-4298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-308-0381
Provider Business Mailing Address Fax Number:
832-412-2983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 WOODWAY DR STE 210
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:
77057-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-308-0381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGHERTY
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-308-0381

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com