Healthcare Provider Details

I. General information

NPI: 1801137260
Provider Name (Legal Business Name): PHYSICAL HEALTHINSTITUTE OF TEXAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 RICHMOND AVE
HOUSTON TX
77027-6817
US

IV. Provider business mailing address

PO BOX 980100
HOUSTON TX
77098-0100
US

V. Phone/Fax

Practice location:
  • Phone: 713-524-5544
  • Fax:
Mailing address:
  • Phone: 713-524-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: JOEY ADOLF
Title or Position: OWNER
Credential: D.C
Phone: 713-524-5544