Provider Demographics
NPI:1780838128
Name:BELTWAY PT CLINIC, LLC
Entity Type:Organization
Organization Name:BELTWAY PT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VARISCO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:337-993-0993
Mailing Address - Street 1:1853 PEARLAND PKWY
Mailing Address - Street 2:SUITE105
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5296
Mailing Address - Country:US
Mailing Address - Phone:337-993-0993
Mailing Address - Fax:337-993-5791
Practice Address - Street 1:1853 PEARLAND PKWY
Practice Address - Street 2:SUITE105
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5296
Practice Address - Country:US
Practice Address - Phone:337-993-0993
Practice Address - Fax:337-993-5791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty