Provider Demographics
NPI:1013261585
Name:THE WOODLANDS PHYSICAL MEDICINE CENTER
Entity Type:Organization
Organization Name:THE WOODLANDS PHYSICAL MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-681-2677
Mailing Address - Street 1:6700 WOODLANDS PKWY
Mailing Address - Street 2:SUITE #200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2575
Mailing Address - Country:US
Mailing Address - Phone:281-681-2677
Mailing Address - Fax:281-681-3077
Practice Address - Street 1:6700 WOODLANDS PKWY
Practice Address - Street 2:SUITE #200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2575
Practice Address - Country:US
Practice Address - Phone:281-681-2677
Practice Address - Fax:281-681-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4522208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty