Healthcare Provider Details

I. General information

NPI: 1639941867
Provider Name (Legal Business Name): DAVID MOPARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20606 STILLHAVEN RD
SPRING TX
77379-1491
US

IV. Provider business mailing address

20606 STILLHAVEN RD
SPRING TX
77379-1491
US

V. Phone/Fax

Practice location:
  • Phone: 312-933-3814
  • Fax:
Mailing address:
  • Phone: 312-933-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1383763
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: