Provider Demographics
NPI:1144414848
Name:ADJ INTEREST LLC
Entity Type:Organization
Organization Name:ADJ INTEREST LLC
Other - Org Name:PROFESSIONAL REHABILITATION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:DELMAR
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:832-868-3301
Mailing Address - Street 1:2906 MORNING BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2119
Mailing Address - Country:US
Mailing Address - Phone:713-436-7088
Mailing Address - Fax:713-436-0935
Practice Address - Street 1:2906 MORNING BROOK WAY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2119
Practice Address - Country:US
Practice Address - Phone:713-436-7088
Practice Address - Fax:713-436-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty