Healthcare Provider Details

I. General information

NPI: 1447822200
Provider Name (Legal Business Name): PHYSICAL THERAPY FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SOUTHWEST FWY STE 510
HOUSTON TX
77027-7334
US

IV. Provider business mailing address

4141 SOUTHWEST FWY STE 510
HOUSTON TX
77027-7334
US

V. Phone/Fax

Practice location:
  • Phone: 281-800-9549
  • Fax: 713-960-1122
Mailing address:
  • Phone: 281-800-9549
  • Fax: 713-960-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: GALVARINO GUERRERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-800-9549