Provider Demographics
NPI:1457804338
Name:PHYSICAL WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICAL WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-764-9454
Mailing Address - Street 1:14614 FALLING CREEK DR STE 217
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-2941
Mailing Address - Country:US
Mailing Address - Phone:832-699-8000
Mailing Address - Fax:281-506-2995
Practice Address - Street 1:12600 N FEATHERWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4441
Practice Address - Country:US
Practice Address - Phone:832-699-8000
Practice Address - Fax:281-506-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty