Provider Demographics
NPI:1467531228
Name:PG DALEY & CR BOONE PTR CLEAR LAKE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PG DALEY & CR BOONE PTR CLEAR LAKE PHYSICAL THERAPY
Other - Org Name:CLEAR LAKE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUS. MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-332-1569
Mailing Address - Street 1:520 BLOSSOM ST
Mailing Address - Street 2:CLEAR LAKE PHYSICAL THERAPY
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-332-1569
Mailing Address - Fax:281-316-2464
Practice Address - Street 1:520 BLOSSOM STREET
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-332-1569
Practice Address - Fax:281-316-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty