Provider Demographics
NPI:1083748602
Name:SHAMROCK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHAMROCK PHYSICAL THERAPY
Other - Org Name:REHABILITATION SERVICES OF HOUSTON
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-790-1221
Mailing Address - Street 1:2305 SAN FELIPE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3401
Mailing Address - Country:US
Mailing Address - Phone:713-790-1221
Mailing Address - Fax:713-520-5493
Practice Address - Street 1:9343 NORTH LOOP E
Practice Address - Street 2:SUITE 204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1251
Practice Address - Country:US
Practice Address - Phone:713-674-2545
Practice Address - Fax:713-674-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456609Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY
TX456609Medicare ID - Type UnspecifiedPHYSICAL THERAPY