Healthcare Provider Details

I. General information

NPI: 1871760496
Provider Name (Legal Business Name): LARRY JOE HIXON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25216 GROGANS PARK DR SUITE 206
THE WOODLANDS TX
77380-2175
US

IV. Provider business mailing address

19107 CRAIGCHESTER
SPRING TX
77388
US

V. Phone/Fax

Practice location:
  • Phone: 281-357-5454
  • Fax: 281-357-5499
Mailing address:
  • Phone: 281-353-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1055424
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: