MEDICARE: HOUSTON AQUATIC THERAPY INSTITUTE, INC.

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
1	174400000X	Specialist	1081297	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65044000	OTHER	TX	TEXAS BOARD OF PT EXAMINE
2	1070712	OTHER	TX	PHYSICAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1902816457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON AQUATIC THERAPY INSTITUTE, INC.

Provider Business Mailing Address
First Line	:	4710 KATY FREEWAY, SUITE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2204
Country	:	US
Telephone Number	:	713-695-7800
Fax Number	:	713-695-7806

Provider Business Practice Location Address
First Line	:	4710 KATY FREEWAY, SUITE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2204
Country	:	US
Telephone Number	:	713-695-7800
Fax Number	:	713-695-7806

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SHELLY LYNETTE LEE
Credential	:
Telephone Number	:	713-695-7800

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/19/2012

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