Provider Demographics
NPI:1265010268
Name:QUALITY LIFE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:QUALITY LIFE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-401-9407
Mailing Address - Street 1:14550 TORREY CHASE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1031
Mailing Address - Country:US
Mailing Address - Phone:281-836-5985
Mailing Address - Fax:281-836-6038
Practice Address - Street 1:14550 TORREY CHASE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1031
Practice Address - Country:US
Practice Address - Phone:281-836-5985
Practice Address - Fax:281-836-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy