Provider Demographics
| NPI: | 1679017776 |
|---|---|
| Name: | BUSYBODY FITNESS & REHAB, PLLC |
| Entity Type: | Organization |
| Organization Name: | BUSYBODY FITNESS & REHAB, PLLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PHYSICAL THERAPIST |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | CHINETRA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | COOK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PT, DPT, CERT DN |
| Authorized Official - Phone: | 832-584-9657 |
| Mailing Address - Street 1: | 2323 S VOSS RD STE 390 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HOUSTON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 77057-3809 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 832-584-9657 |
| Mailing Address - Fax: | 832-827-4255 |
| Practice Address - Street 1: | 2323 S VOSS RD STE 390 |
| Practice Address - Street 2: | |
| Practice Address - City: | HOUSTON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 77057-3809 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 832-584-9657 |
| Practice Address - Fax: | 832-827-4255 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-12-07 |
| Last Update Date: | 2019-06-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 1221275 | 225100000X, 2251C2600X, 2251G0304X, 2251P0200X, 2251S0007X, 2251X0800X, 261Q00000X, 305R00000X, 320900000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251C2600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Cardiopulmonary | Group - Multi-Specialty |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 305R00000X | Managed Care Organizations | Preferred Provider Organization | Group - Multi-Specialty | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 517353 | Medicaid |
