Provider Demographics
NPI:1235200304
Name:HOUSTON, JOHN W (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HIGHWAY 11 N STE E
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2070
Mailing Address - Country:US
Mailing Address - Phone:769-242-2626
Mailing Address - Fax:769-242-2685
Practice Address - Street 1:48 CAMELLIA RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7077
Practice Address - Country:US
Practice Address - Phone:601-798-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist