Provider Demographics
NPI:1073196382
Name:SPE MEDICAL & PHYSICAL THERAPY CLINIC PLLC
Entity Type:Organization
Organization Name:SPE MEDICAL & PHYSICAL THERAPY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ENELICHI
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:281-660-8661
Mailing Address - Street 1:10103 FONDREN RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:128-166-0866
Mailing Address - Fax:
Practice Address - Street 1:10103 FONDREN RD STE 150A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4556
Practice Address - Country:US
Practice Address - Phone:128-166-0866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty