Provider Demographics
NPI:1396105896
Name:NEPOMNICHY, JOE (PTA)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:NEPOMNICHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:JOE
Other - Middle Name:LYNN
Other - Last Name:NEPOMNICHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:2 RIVERWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 RIVERWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1939
Practice Address - Country:US
Practice Address - Phone:281-724-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2047601225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant