Provider Demographics
NPI:1518970276
Name:THE WOODLANDS AQUATIC & LAND THERAPY
Entity Type:Organization
Organization Name:THE WOODLANDS AQUATIC & LAND THERAPY
Other - Org Name:TORRANCE EARLE DBA THE WOODLANDS AQUATIC & LAND THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-646-1935
Mailing Address - Street 1:395 SAWDUST RD
Mailing Address - Street 2:PMB 2033
Mailing Address - City:WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-646-1935
Mailing Address - Fax:281-646-0927
Practice Address - Street 1:25003 PITKIN RD
Practice Address - Street 2:STE E 100
Practice Address - City:WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77386
Practice Address - Country:US
Practice Address - Phone:281-367-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00963WMedicare ID - Type Unspecified