Provider Demographics
NPI:1962925420
Name:PETE, KENNETH (PTA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:PETE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4607
Mailing Address - Country:US
Mailing Address - Phone:832-896-1035
Mailing Address - Fax:
Practice Address - Street 1:6731 STELLA LINK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-4342
Practice Address - Country:US
Practice Address - Phone:713-662-9900
Practice Address - Fax:713-662-9919
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4057597225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437334182Medicaid