Provider Demographics
NPI:1679236038
Name:DISTINCTIVE PHYSICAL THERAPY AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:DISTINCTIVE PHYSICAL THERAPY AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:HOWZE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:281-394-4704
Mailing Address - Street 1:27495 HALEY LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4211
Mailing Address - Country:US
Mailing Address - Phone:281-394-4704
Mailing Address - Fax:281-768-3602
Practice Address - Street 1:9201 PINECROFT DR STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3889
Practice Address - Country:US
Practice Address - Phone:281-394-4704
Practice Address - Fax:281-768-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1208453OtherPHYSICAL THERAPIST