Healthcare Provider Details

I. General information

NPI: 1114754066
Provider Name (Legal Business Name): EVERGREEN PHYSIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13031 WORTHAM CENTER DR
HOUSTON TX
77065-5662
US

IV. Provider business mailing address

2637 N 400 E STE 164
NORTH OGDEN UT
84414-2240
US

V. Phone/Fax

Practice location:
  • Phone: 832-280-2500
  • Fax:
Mailing address:
  • Phone: 214-970-6817
  • Fax: 844-803-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLEY ABRAHAM THOMAS
Title or Position: OWNER
Credential: MD
Phone: 832-856-0412