=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023156668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MLD & PT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 810 HOLTON ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-546-6438
-----------------------------------------------------
Fax | 713-664-9051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 HOLTON ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-546-6438
-----------------------------------------------------
Fax | 713-664-9051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PHYSICAL THERAPIST
-----------------------------------------------------
Name | MS. MARGARET SMART WILLIAMS
-----------------------------------------------------
Credential | PHYSICAL THERAPIST
-----------------------------------------------------
Telephone | 281-546-6438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 1051670
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------