Provider Demographics
NPI:1467824086
Name:PHYSICAL THERAPY CARE OF FORT BEND
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CARE OF FORT BEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:381-347-8900
Mailing Address - Street 1:1500 JACKSON ST
Mailing Address - Street 2:400
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3668
Mailing Address - Country:US
Mailing Address - Phone:281-344-8900
Mailing Address - Fax:281-344-8926
Practice Address - Street 1:1500 JACKSON ST
Practice Address - Street 2:400
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3668
Practice Address - Country:US
Practice Address - Phone:281-344-8900
Practice Address - Fax:281-344-8926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1261205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179385301Medicaid
TX00471ZMedicare UPIN