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General NPI Number Information
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NPI Number | 1174730014
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Entity Type | Organization
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Legal Business Name | LUNDHOLM SURGICAL GROUP PHYSICAL THERAPY DPT
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1340 CHARLES ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2200
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Country | US
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Telephone | 815-399-1975
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Fax | 815-399-3207
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Provider Business Mailing Address
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Address Line | 1300 W SAM HOUSTON PKWY S SUITE 300
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City | HOUSTON
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State | TX
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Zip | 77042-2447
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Country | US
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Telephone | 713-297-7000
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Fax | 713-297-7090
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Authorized Official
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Title or Position | VP, AUTHORIZED OFFICIAL
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Name | JANNA P. KING
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Credential | JD
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Telephone | 713-297-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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