Provider Demographics
NPI:1306659149
Name:THIRD COAST WELLNESS
Entity type:Organization
Organization Name:THIRD COAST WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETTY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-206-8763
Mailing Address - Street 1:9000 SOUTHWEST FWY STE 260
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1520
Mailing Address - Country:US
Mailing Address - Phone:713-367-2790
Mailing Address - Fax:866-598-4096
Practice Address - Street 1:9000 SOUTHWEST FWY STE 260
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1520
Practice Address - Country:US
Practice Address - Phone:713-367-2790
Practice Address - Fax:866-598-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy