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NPI Code Detail

MEDICARE: MS. PHYLLIS E TAL PT

MEDICARE:  MS. PHYLLIS E TAL  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1103125

General Provider Information

NPI Number : 1538271895
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PHYLLIS E TAL PT
Provider Business Mailing Address
First Line : 1530 HAVEN LOCK DR
Second Line :
City : HOUSTON
State : TX
Zip : 77077-4208
Country : US
Telephone Number : 281-920-4399
Fax Number :
Provider Business Practice Location Address
First Line : 1530 HAVEN LOCK DR
Second Line :
City : HOUSTON
State : TX
Zip : 77077-4208
Country : US
Telephone Number : 281-920-4399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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Directions to “ MS. PHYLLIS E TAL PT” Practice Location

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