Healthcare Provider Details

I. General information

NPI: 1295122547
Provider Name (Legal Business Name): FRSTTEXAS CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 KATY FWY SUITE 620
HOUSTON TX
77079-2126
US

IV. Provider business mailing address

11211 KATY FWY SUITE 620
HOUSTON TX
77079-2126
US

V. Phone/Fax

Practice location:
  • Phone: 832-962-3778
  • Fax:
Mailing address:
  • Phone: 832-962-3778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number21625
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1237869
License Number StateTX

VIII. Authorized Official

Name: DANIEL V BODIN
Title or Position: DIRECTOR
Credential:
Phone: 832-962-3778