Provider Demographics
NPI:1619490828
Name:HOUSE, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SAGE RD APT 1161
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6330
Mailing Address - Country:US
Mailing Address - Phone:832-564-5030
Mailing Address - Fax:
Practice Address - Street 1:3000 SAGE RD
Practice Address - Street 2:1161
Practice Address - City:HOUSTON
Practice Address - State:TN
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:832-564-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT1110828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX225700000XOtherMT110828