Provider Demographics
NPI:1669124772
Name:IDEAL PHYSICAL THERAPY OF TEXAS LLC
Entity type:Organization
Organization Name:IDEAL PHYSICAL THERAPY OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-296-2222
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2002 W GRAND PKWY N STE 125
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2518
Practice Address - Country:US
Practice Address - Phone:281-710-9001
Practice Address - Fax:281-697-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies