Healthcare Provider Details

I. General information

NPI: 1952123036
Provider Name (Legal Business Name): NOVA LEA SBRUSCH PT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21720 KINGSLAND BLVD
KATY TX
77450-2550
US

IV. Provider business mailing address

2535 GLEN HAVEN LN
RICHMOND TX
77406-2387
US

V. Phone/Fax

Practice location:
  • Phone: 281-579-5735
  • Fax:
Mailing address:
  • Phone: 713-302-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1143287
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: