Provider Demographics
NPI:1881832384
Name:KATY PT CLINIC, L.L.C.
Entity Type:Organization
Organization Name:KATY PT CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:PROF
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:PO BOX 80964
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0964
Mailing Address - Country:US
Mailing Address - Phone:337-993-0993
Mailing Address - Fax:337-993-5791
Practice Address - Street 1:19770 KINGSLAND BLVD
Practice Address - Street 2:SUITE 300B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1031
Practice Address - Country:US
Practice Address - Phone:281-647-7720
Practice Address - Fax:281-647-7721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664840000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty