Provider Demographics
NPI:1760917165
Name:THE SECRET PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:THE SECRET PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-240-0677
Mailing Address - Street 1:9119 HIGHWAY 6 STE 230-452
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4876
Mailing Address - Country:US
Mailing Address - Phone:713-240-0677
Mailing Address - Fax:
Practice Address - Street 1:4101 GREENBRIAR ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-5244
Practice Address - Country:US
Practice Address - Phone:713-240-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy