=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174559595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICAL THERAPY & SPINE INSTITUTE LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14142 S BELL RD UNIT B-12
-----------------------------------------------------
City | HOMER GLEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60491-8465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-301-2747
-----------------------------------------------------
Fax | 708-301-8179
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 W SAM HOUSTON PKWY S SUITE 300
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77042-2447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-297-7000
-----------------------------------------------------
Fax | 713-297-7090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JANNA P. KING
-----------------------------------------------------
Credential | JD
-----------------------------------------------------
Telephone | 713-297-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------