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General NPI Number Information
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NPI Number | 1205373628
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Entity Type | Organization
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Legal Business Name | BODY BY PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 7777 SOUTHWEST FWY SUITE #640
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City | HOUSTON
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State | TX
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Zip | 77074-1802
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Country | US
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Telephone | 713-270-0477
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Fax | 713-270-7655
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Provider Business Mailing Address
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Address Line | PO BOX 770211
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City | HOUSTON
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State | TX
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Zip | 77215-0211
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Country | US
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Telephone | 832-620-1225
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, CEO
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Name | DR. TARO WICHMAN
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Credential | PT, DPT, MTC
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Telephone | 832-620-1225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1272156
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License Number State | TX
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