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General NPI Number Information
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NPI Number | 1609574904
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Entity Type | Organization
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Legal Business Name | VISTA THERAPEUTIC LLC
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 11301 RICHMOND AVE STE K109
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City | HOUSTON
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State | TX
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Zip | 77082-5549
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Country | US
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Telephone | 832-328-5350
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Fax | 346-571-6898
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Provider Business Mailing Address
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Address Line | 11301 RICHMOND AVE STE K109
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City | HOUSTON
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State | TX
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Zip | 77082-5549
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Country | US
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Telephone | 832-328-5350
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Fax | 346-571-6898
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Authorized Official
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Title or Position | ADMINISTRATOR/MANAGER
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Name | MR. HAKEEM A YUSUF
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Credential |
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Telephone | 832-576-7579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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