Provider Demographics
NPI:1457536609
Name:CORE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:HAVANA
Authorized Official - Last Name:FELTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PLT,CFT
Authorized Official - Phone:979-297-2900
Mailing Address - Street 1:PO BOX 1946
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77516-1946
Mailing Address - Country:US
Mailing Address - Phone:979-297-2900
Mailing Address - Fax:979-297-2901
Practice Address - Street 1:230 PARKING WAY
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566
Practice Address - Country:US
Practice Address - Phone:979-297-2900
Practice Address - Fax:979-297-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055911261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179372101Medicaid
TX612153Medicare PIN