Provider Demographics
NPI:1619023710
Name:DAVIDSON PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:DAVIDSON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:PT
Authorized Official - Phone:713-864-0556
Mailing Address - Street 1:1919 NORTH LOOP W
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1374
Mailing Address - Country:US
Mailing Address - Phone:713-864-0556
Mailing Address - Fax:713-864-1059
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:SUITE 130
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1374
Practice Address - Country:US
Practice Address - Phone:713-864-0556
Practice Address - Fax:713-864-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007458261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022QJOtherBLUE CROSS BLUE SHIELD
TXZ06500293Medicaid
TX650029Medicare ID - Type Unspecified