Provider Demographics
NPI:1477764777
Name:HWF IMPACT
Entity Type:Organization
Organization Name:HWF IMPACT
Other - Org Name:HOUSTON WORK & FITNESS IMPACT
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:IBARQUEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:713-680-0199
Mailing Address - Street 1:7102 LONG POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055
Mailing Address - Country:US
Mailing Address - Phone:713-680-0199
Mailing Address - Fax:713-680-2910
Practice Address - Street 1:7102 LONG POINT ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-680-0199
Practice Address - Fax:713-680-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX103009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty