Provider Demographics
NPI:1396890786
Name:SHAMROCK PHYSICAL THERAPY CLINIC, INC.
Entity type:Organization
Organization Name:SHAMROCK PHYSICAL THERAPY CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:713-790-1221
Mailing Address - Street 1:2305 SAN FELIPE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3401
Mailing Address - Country:US
Mailing Address - Phone:713-790-1221
Mailing Address - Fax:
Practice Address - Street 1:2305 SAN FELIPE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-3401
Practice Address - Country:US
Practice Address - Phone:713-790-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456609Medicare ID - Type Unspecified