Provider Demographics
NPI:1134506595
Name:MCDONOUGH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MCDONOUGH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MTC
Authorized Official - Phone:281-758-5314
Mailing Address - Street 1:14814 S CANARY YELLOW CIR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6633
Mailing Address - Country:US
Mailing Address - Phone:281-758-5314
Mailing Address - Fax:281-758-5314
Practice Address - Street 1:14814 S CANARY YELLOW CIR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6633
Practice Address - Country:US
Practice Address - Phone:281-758-5314
Practice Address - Fax:281-758-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1198711261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy