Provider Demographics
NPI:1386676716
Name:LARRY M. BURLEIGH
Entity Type:Organization
Organization Name:LARRY M. BURLEIGH
Other - Org Name:BURLEIGH PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURLEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:832-237-3331
Mailing Address - Street 1:12914 FM 1960 RD W STE F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5311
Mailing Address - Country:US
Mailing Address - Phone:832-237-4638
Mailing Address - Fax:
Practice Address - Street 1:12914 FM 1960 RD W STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5311
Practice Address - Country:US
Practice Address - Phone:832-237-4638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454874Medicare ID - Type UnspecifiedCORF MEDICARE