Provider Demographics
NPI:1740552900
Name:PHYSIOTECH DIAGNOSTIC SERVICES LLC
Entity type:Organization
Organization Name:PHYSIOTECH DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRENDRAKUMAR
Authorized Official - Middle Name:C
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PHD, LPC
Authorized Official - Phone:281-731-6092
Mailing Address - Street 1:4111 HOUGHTON CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3959
Mailing Address - Country:US
Mailing Address - Phone:281-731-6092
Mailing Address - Fax:281-957-5609
Practice Address - Street 1:4111 HOUGHTON CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3959
Practice Address - Country:US
Practice Address - Phone:281-731-6092
Practice Address - Fax:281-957-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory