Provider Demographics
NPI:1396206793
Name:IMPACT CARE THERAPY
Entity Type:Organization
Organization Name:IMPACT CARE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:MUGU
Authorized Official - Last Name:MIANO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, NCS
Authorized Official - Phone:346-341-7307
Mailing Address - Street 1:3841 CARTWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2443
Mailing Address - Country:US
Mailing Address - Phone:832-322-9299
Mailing Address - Fax:
Practice Address - Street 1:3841 CARTWRIGHT RD
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2443
Practice Address - Country:US
Practice Address - Phone:832-303-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty