Healthcare Provider Details

I. General information

NPI: 1780997072
Provider Name (Legal Business Name): HOPE PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 ROCKWOOD LN SUITE 315
AUSTIN TX
78757-1106
US

IV. Provider business mailing address

PO BOX 143744
AUSTIN TX
78714-3744
US

V. Phone/Fax

Practice location:
  • Phone: 512-323-0802
  • Fax: 512-323-0803
Mailing address:
  • Phone: 512-323-0802
  • Fax: 512-323-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1137131
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1137131
License Number StateTX

VIII. Authorized Official

Name: MS. LISA M JEFFERY
Title or Position: OWNER
Credential: PT, DPT, OCS
Phone: 512-796-3954