Provider Demographics
NPI:1720351059
Name:SHOULDER ELBOW & HAND THERAPY SPECIALIST PC
Entity Type:Organization
Organization Name:SHOULDER ELBOW & HAND THERAPY SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-298-5811
Mailing Address - Street 1:8850 SIX PINES DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2683
Mailing Address - Country:US
Mailing Address - Phone:281-298-5811
Mailing Address - Fax:281-298-5849
Practice Address - Street 1:8850 SIX PINES DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2683
Practice Address - Country:US
Practice Address - Phone:281-298-5811
Practice Address - Fax:281-298-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110312225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL32710Medicare UPIN