Provider Demographics
NPI:1215436399
Name:JOINT SELECT PT LLC
Entity type:Organization
Organization Name:JOINT SELECT PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-598-2135
Mailing Address - Street 1:12000 RICHMOND AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12000 RICHMOND AVE STE 135
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2455
Practice Address - Country:US
Practice Address - Phone:832-598-2135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683210000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX683210000OtherSTATE LICENSE - PTOT