Provider Demographics
NPI:1003357617
Name:POENITZSCH, JAMES (PT, DPT, COMT, CSCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:POENITZSCH
Suffix:
Gender:M
Credentials:PT, DPT, COMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12916 SOUTHERN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3690
Mailing Address - Country:US
Mailing Address - Phone:979-253-0360
Mailing Address - Fax:
Practice Address - Street 1:11540 MAGNOLIA PKWY STE G
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1649
Practice Address - Country:US
Practice Address - Phone:281-213-0642
Practice Address - Fax:281-213-0324
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1278358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist