Provider Demographics
NPI:1457302697
Name:CENTER FOR BALANCE & NEUROLOGICAL PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CENTER FOR BALANCE & NEUROLOGICAL PHYSICAL THERAPY LLC
Other - Org Name:BALANCE DIAGNOSTIC & THERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:713-669-0042
Mailing Address - Street 1:4141 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7313
Mailing Address - Country:US
Mailing Address - Phone:713-669-0042
Mailing Address - Fax:713-223-1801
Practice Address - Street 1:4141 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7313
Practice Address - Country:US
Practice Address - Phone:713-669-0042
Practice Address - Fax:713-223-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144210225100000X
TX11598882251N0400X
TX11137692251N0400X
TX11672602251N0400X
TX107939225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3395OtherBCBS PROVIDER NUMBER
DC1391OtherMEDICARE RAILROAD
TX8T3395OtherBCBS PROVIDER NUMBER