Provider Demographics
NPI:1023295425
Name:TEKTONIC ATHLETIC DEVELOPMENT & REHABILITATION
Entity type:Organization
Organization Name:TEKTONIC ATHLETIC DEVELOPMENT & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-482-9635
Mailing Address - Street 1:1623 PINE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1337
Mailing Address - Country:US
Mailing Address - Phone:832-482-9635
Mailing Address - Fax:
Practice Address - Street 1:602 PRUITT RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3017
Practice Address - Country:US
Practice Address - Phone:832-482-9635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy