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General NPI Number Information
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NPI Number | 1376837922
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Entity Type | Organization
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Legal Business Name | SUPPLEMENTAL HEALTHCARE
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 4620 N BRAESWOOD BLVD APT 52
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City | HOUSTON
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State | TX
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Zip | 77096-2847
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Country | US
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Telephone | 832-878-1522
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Fax | 832-516-8063
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Provider Business Mailing Address
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Address Line | 4620 N BRAESWOOD BLVD APT 52
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City | HOUSTON
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State | TX
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Zip | 77096-2847
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Country | US
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Telephone | 832-878-1522
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Fax | 832-516-8063
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MRS. KIMBERLY TERESA JOHNSON
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Credential | BS
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Telephone | 832-878-1522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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