=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093809725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPORTS INSTITUTE OF PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7155 ATASCOCITA RD
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77346-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-812-8304
-----------------------------------------------------
Fax | 281-812-8306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7155 ATASCOCITA RD
-----------------------------------------------------
City | HUMBLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77346-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-812-8304
-----------------------------------------------------
Fax | 281-812-8306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. KAREE SCHMIDT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-812-8304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------