Provider Demographics
NPI:1922740075
Name:DIRECT PT OF HUNTSVILLE TX
Entity Type:Organization
Organization Name:DIRECT PT OF HUNTSVILLE TX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-994-8752
Mailing Address - Street 1:810 PINEDALE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-7441
Mailing Address - Country:US
Mailing Address - Phone:936-994-8752
Mailing Address - Fax:
Practice Address - Street 1:3200 ROBINSON CREEK PKWY STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-2298
Practice Address - Country:US
Practice Address - Phone:936-994-8752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty