Provider Demographics
NPI:1205425907
Name:KA OSTEOPRACTIC PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:KA OSTEOPRACTIC PHYSICAL THERAPY & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY SAM
Authorized Official - Middle Name:DARIA
Authorized Official - Last Name:AING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:713-277-8738
Mailing Address - Street 1:1414 N SHEPHERD DR APT 361
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4092
Mailing Address - Country:US
Mailing Address - Phone:713-277-8738
Mailing Address - Fax:
Practice Address - Street 1:1102 PINEMONT DR STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1323
Practice Address - Country:US
Practice Address - Phone:713-277-8738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-16
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy