MEDICARE: ERGONOMIC REHABILITATION OF HOUSTON, LLC

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	2251X0800X	Orthopedic Physical Therapist	1104503	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0031JC	OTHER	TX	BCBS GROUP PROV#
2	8T0170	OTHER	TX	BCBS INDIVIDUAL PROV#

General Provider Information

NPI Number	:	1912994831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERGONOMIC REHABILITATION OF HOUSTON, LLC

Provider Business Mailing Address
First Line	:	283 LOCKHAVEN DR
Second Line	:	SUITE 315
City	:	HOUSTON
State	:	TX
Zip	:	77073-5525
Country	:	US
Telephone Number	:	281-821-4200
Fax Number	:	281-821-4880

Provider Business Practice Location Address
First Line	:	283 LOCKHAVEN DR
Second Line	:	SUITE 315
City	:	HOUSTON
State	:	TX
Zip	:	77073-5525
Country	:	US
Telephone Number	:	281-821-4200
Fax Number	:	281-821-4880

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/CO-OWNER
Name	:	MR. STEVEN VINCENT SOPHER
Credential	:	PT
Telephone Number	:	281-821-4200

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	03/18/2008

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