Provider Demographics
NPI:1538316211
Name:BLUESTONE HEALTHCARE SERVICES, PLLC
Entity Type:Organization
Organization Name:BLUESTONE HEALTHCARE SERVICES, PLLC
Other - Org Name:BLUESTONE PHYSICAL THERAPY.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CHUKWUDI
Authorized Official - Last Name:EBEM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-472-2020
Mailing Address - Street 1:13279 POND SPRINGS RD
Mailing Address - Street 2:UNIT 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7161
Mailing Address - Country:US
Mailing Address - Phone:512-472-2020
Mailing Address - Fax:512-472-2021
Practice Address - Street 1:13279 POND SPRINGS RD
Practice Address - Street 2:UNIT 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7161
Practice Address - Country:US
Practice Address - Phone:512-472-2020
Practice Address - Fax:512-472-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193315201Medicaid
TX8F10161Medicare PIN
TX613135Medicare PIN
TX0A3153Medicare PIN