Provider Demographics
NPI:1669485058
Name:PEARLAND THERAPEUTICS LLC
Entity Type:Organization
Organization Name:PEARLAND THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:281-412-7901
Mailing Address - Street 1:8703 BROADWAY ST STE 121
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8098
Mailing Address - Country:US
Mailing Address - Phone:281-412-7901
Mailing Address - Fax:281-412-7902
Practice Address - Street 1:8703 BROADWAY ST.
Practice Address - Street 2:SUITE 121
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8098
Practice Address - Country:US
Practice Address - Phone:713-382-7418
Practice Address - Fax:713-436-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188434801Medicaid
TX188434801Medicaid
676661Medicare Oscar/Certification