MEDICARE: INJURY & PHYSICAL THERAPY CLINIC 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1982770210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY & PHYSICAL THERAPY CLINIC LLC

Provider Business Mailing Address
First Line	:	10610 FONDREN RD STE 124
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5446
Country	:	US
Telephone Number	:	713-981-5167
Fax Number	:	713-981-5553

Provider Business Practice Location Address
First Line	:	10610 FONDREN RD STE 124
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5446
Country	:	US
Telephone Number	:	713-981-5167
Fax Number	:	713-981-5553

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CYNTHIA GARDNIER
Credential	:
Telephone Number	:	713-981-5167

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/15/2011

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