=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215436399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOINT SELECT PT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2018
-----------------------------------------------------
Last Update Date | 02/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12000 RICHMOND AVE STE 135
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77082-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-598-2135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12000 RICHMOND AVE STE 135
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77082-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. SHAGUN TYAGI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-598-2135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 683210000
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------