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General NPI Number Information
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NPI Number | 1679236038
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Entity Type | Organization
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Legal Business Name | DISTINCTIVE PHYSICAL THERAPY AND WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 9201 PINECROFT DR STE 200
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City | SHENANDOAH
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State | TX
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Zip | 77380-3889
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Country | US
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Telephone | 281-394-4704
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Fax | 281-768-3602
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Provider Business Mailing Address
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Address Line | 27495 HALEY LN
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City | SPRING
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State | TX
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Zip | 77386-4211
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Country | US
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Telephone | 281-394-4704
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Fax | 281-768-3602
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE HOWZE MOORE
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Credential | DPT
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Telephone | 281-394-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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