Provider Demographics
NPI:1497292031
Name:TRADE WINDS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TRADE WINDS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DESIMIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-421-8500
Mailing Address - Street 1:2505 STONE HOLLOW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5631
Mailing Address - Country:US
Mailing Address - Phone:979-421-8500
Mailing Address - Fax:979-421-8283
Practice Address - Street 1:2505 STONE HOLLOW DR STE 200
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5631
Practice Address - Country:US
Practice Address - Phone:979-421-8500
Practice Address - Fax:979-421-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty