Provider Demographics
NPI:1124358353
Name:WILCREST PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:WILCREST PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-575-8288
Mailing Address - Street 1:11589 S WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-4752
Mailing Address - Country:US
Mailing Address - Phone:281-575-8288
Mailing Address - Fax:281-575-6833
Practice Address - Street 1:11589 S WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-4752
Practice Address - Country:US
Practice Address - Phone:281-575-8288
Practice Address - Fax:281-575-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty