Provider Demographics
NPI:1083722722
Name:US PT MANAGED CARE INC
Entity Type:Organization
Organization Name:US PT MANAGED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:13321 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4270
Mailing Address - Country:US
Mailing Address - Phone:804-897-0704
Mailing Address - Fax:804-897-1681
Practice Address - Street 1:13321 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE E
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4270
Practice Address - Country:US
Practice Address - Phone:804-897-0704
Practice Address - Fax:804-897-1681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US PT MANAGED CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496717Medicare Oscar/Certification