Provider Demographics
NPI:1134847957
Name:DECKERT, DEVIN MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:MICHAEL
Last Name:DECKERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 S MASON RD APT 428
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4477
Mailing Address - Country:US
Mailing Address - Phone:951-816-5322
Mailing Address - Fax:
Practice Address - Street 1:23960 KATY FWY STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0893
Practice Address - Country:US
Practice Address - Phone:281-644-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1360342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist