1780997072 NPI number — HOPE PHYSICAL THERAPY AND WELLNESS CENTER, LLC

Table of content: (NPI 1780997072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780997072 NPI number — HOPE PHYSICAL THERAPY AND WELLNESS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE PHYSICAL THERAPY AND WELLNESS CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1780997072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 143744
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:
78714-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-323-0802
Provider Business Mailing Address Fax Number:
512-323-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7817 ROCKWOOD LN
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78757-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-323-0802
Provider Business Practice Location Address Fax Number:
512-323-0803
Provider Enumeration Date:
07/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFERY
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-796-3954

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1137131 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X , with the licence number: 1137131 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1137131 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com