Provider Demographics
NPI:1467850057
Name:LAKE CONROE PHYSICAL THERAPY AND REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:LAKE CONROE PHYSICAL THERAPY AND REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:409-539-0587
Mailing Address - Street 1:11459 REGAL HILL CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-9648
Mailing Address - Country:US
Mailing Address - Phone:409-539-0587
Mailing Address - Fax:936-588-6017
Practice Address - Street 1:11459 REGAL HILL CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-9648
Practice Address - Country:US
Practice Address - Phone:409-539-0587
Practice Address - Fax:936-588-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1122646261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy