Provider Demographics
NPI:1588761928
Name:HOUSTON SOUTHWEST PHYSICAL THERAPY
Entity type:Organization
Organization Name:HOUSTON SOUTHWEST PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-265-1705
Mailing Address - Street 1:PO BOX 18576
Mailing Address - Street 2:SUITE
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-8576
Mailing Address - Country:US
Mailing Address - Phone:281-265-1705
Mailing Address - Fax:281-265-0848
Practice Address - Street 1:7023 KAYLEIGH CT
Practice Address - Street 2:SUITE A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5534
Practice Address - Country:US
Practice Address - Phone:281-265-1705
Practice Address - Fax:281-265-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX646410000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6400048OtherEVERCARE PROVIDER ID
TX1080350Medicaid
TX1080350Medicaid
TXTXB115675Medicare PIN