Provider Demographics
NPI:1376131144
Name:BULLETPROOF PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BULLETPROOF PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-635-0372
Mailing Address - Street 1:2420 LEELAND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-5202
Mailing Address - Country:US
Mailing Address - Phone:757-635-0372
Mailing Address - Fax:
Practice Address - Street 1:1005 ENNIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-3803
Practice Address - Country:US
Practice Address - Phone:713-907-1276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy