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General NPI Number Information
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NPI Number | 1225048887
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1605 E DEL MAR BLVD STE 14
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City | LAREDO
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State | TX
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Zip | 78041-6517
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Country | US
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Telephone | 956-725-2882
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Fax | 956-725-2880
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Provider Business Mailing Address
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Address Line | 4455 SPID SUITE 8
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411
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Country | US
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Telephone | 361-855-8004
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Fax | 361-986-0751
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Authorized Official
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Title or Position | PHYSICAL THERAPY
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Name | CHRISTOPHER NEPHEW
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Credential | DPT
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Telephone | 361-855-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT11145852
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License Number State | TX
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