Provider Demographics
NPI:1902816457
Name:HOUSTON AQUATIC THERAPY INSTITUTE, INC.
Entity Type:Organization
Organization Name:HOUSTON AQUATIC THERAPY INSTITUTE, INC.
Other - Org Name:TEXAS ORTHOPAEDIC AND AQUATIC THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-695-7800
Mailing Address - Street 1:4710 KATY FREEWAY, SUITE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2204
Mailing Address - Country:US
Mailing Address - Phone:713-695-7800
Mailing Address - Fax:713-695-7806
Practice Address - Street 1:4710 KATY FREEWAY, SUITE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2204
Practice Address - Country:US
Practice Address - Phone:713-695-7800
Practice Address - Fax:713-695-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1081297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65044000OtherTEXAS BOARD OF PT EXAMINE
TX1070712OtherPHYSICAL THERAPIST LICENSE
TX00697ZMedicare UPIN
TX8F1507Medicare UPIN