1720351059 NPI number — SHOULDER ELBOW & HAND THERAPY SPECIALIST PC

Table of content: MEENA DUGATKIN PSY AIT MA (NPI 1336667872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720351059 NPI number — SHOULDER ELBOW & HAND THERAPY SPECIALIST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOULDER ELBOW & HAND THERAPY SPECIALIST PC
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:
1720351059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8850 SIX PINES DR
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-2683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-298-5811
Provider Business Mailing Address Fax Number:
281-298-5849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8850 SIX PINES DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-2683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-298-5811
Provider Business Practice Location Address Fax Number:
281-298-5849
Provider Enumeration Date:
02/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PUETT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
281-298-5811

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  110312 , 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)





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