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General NPI Number Information
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NPI Number | 1558740514
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Entity Type | Organization
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Legal Business Name | IASI, INC.
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 711 AVENUE E
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City | STAFFORD
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State | TX
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Zip | 77477-5801
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Country | US
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Telephone | 281-208-0835
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2519
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City | SUGAR LAND
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State | TX
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Zip | 77487-2519
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Country | US
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Telephone | 281-208-0835
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANDY BORGEN
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Credential |
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Telephone | 281-208-0835
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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 | 1160378
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License Number State | TX
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