Provider Demographics
NPI:1821553041
Name:PELVIC PLACE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PELVIC PLACE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAGOH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:904-822-9045
Mailing Address - Street 1:2909 OAKMIST RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TN
Mailing Address - Zip Code:77854
Mailing Address - Country:US
Mailing Address - Phone:804-822-9045
Mailing Address - Fax:832-565-1063
Practice Address - Street 1:2 CHELSEA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-6202
Practice Address - Country:US
Practice Address - Phone:804-822-9045
Practice Address - Fax:832-565-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty