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General NPI Number Information
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NPI Number | 1407704836
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Entity Type | Organization
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Legal Business Name | PUSH MEDSPA
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 25301 BOROUGH PARK DR STE 112
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3568
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Country | US
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Telephone | 936-228-1764
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Fax | 936-353-0055
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Provider Business Mailing Address
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Address Line | 25301 BOROUGH PARK DR STE 112
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City | THE WOODLANDS
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State | TX
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Zip | 77380-3568
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Country | US
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Telephone | 936-228-1764
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Fax | 936-353-0055
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ARETHA HORTON
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Credential |
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Telephone | 832-392-5495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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