Provider Demographics
NPI:1710209689
Name:JUMP START PHYSICAL THERAPY
Entity Type:Organization
Organization Name:JUMP START PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-656-7660
Mailing Address - Street 1:38043 WINDY RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355
Mailing Address - Country:US
Mailing Address - Phone:832-656-7660
Mailing Address - Fax:832-559-7720
Practice Address - Street 1:38043 WINDY RIDGE TRL
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355
Practice Address - Country:US
Practice Address - Phone:832-656-7660
Practice Address - Fax:832-559-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206612801Medicaid