=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710743794
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERNON ENTERPRISE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 02/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 GREEN OAK DR STE 150
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-533-2473
-----------------------------------------------------
Fax | 832-533-8348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8190 BARKER CYPRESS RD STE 1900-512
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-1223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-533-2473
-----------------------------------------------------
Fax | 832-533-8348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HEATHER OLANA TAYLOR VERNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 662-549-3948
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------