Provider Demographics
NPI:1750314985
Name:LET'S MOVE PEDIATRIC AND ADULT PHYSICAL THERAPY
Entity type:Organization
Organization Name:LET'S MOVE PEDIATRIC AND ADULT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:713-218-6683
Mailing Address - Street 1:8427A STELLA LINK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2915
Mailing Address - Country:US
Mailing Address - Phone:713-218-6683
Mailing Address - Fax:713-349-0403
Practice Address - Street 1:8427A STELLA LINK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-2915
Practice Address - Country:US
Practice Address - Phone:713-218-6683
Practice Address - Fax:713-349-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0217440Medicaid
TX456876Medicare ID - Type UnspecifiedORF