Provider Demographics
NPI:1982770210
Name:INJURY & PHYSICAL THERAPY CLINIC LLC
Entity Type:Organization
Organization Name:INJURY & PHYSICAL THERAPY CLINIC LLC
Other - Org Name:INJURY REHAB CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-981-5167
Mailing Address - Street 1:10610 FONDREN RD STE 124
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-5446
Mailing Address - Country:US
Mailing Address - Phone:713-981-5167
Mailing Address - Fax:713-981-5553
Practice Address - Street 1:10610 FONDREN RD STE 124
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-5446
Practice Address - Country:US
Practice Address - Phone:713-981-5167
Practice Address - Fax:713-981-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty