Provider Demographics
NPI:1376714568
Name:CONSULTATION PHYSICAL THERAPY OF TEXAS, P.C.
Entity Type:Organization
Organization Name:CONSULTATION PHYSICAL THERAPY OF TEXAS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST IN CHARGE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:713-961-7852
Mailing Address - Street 1:427 W 20TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2441
Mailing Address - Country:US
Mailing Address - Phone:713-961-7852
Mailing Address - Fax:713-961-0812
Practice Address - Street 1:427 W 20TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2441
Practice Address - Country:US
Practice Address - Phone:713-961-7852
Practice Address - Fax:713-961-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630230000174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
650536Medicare PIN