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General NPI Number Information
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NPI Number | 1720484678
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Entity Type | Organization
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Legal Business Name | AGILITY PHYSICAL THERAPY AND SPORTS REHABILITATION, LLC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 11450 SPACE CENTER BLVD SUITE 201
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City | HOUSTON
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State | TX
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Zip | 77059-3641
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Country | US
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Telephone | 281-998-0901
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Fax |
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Provider Business Mailing Address
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Address Line | 11450 SPACE CENTER BLVD SUITE 201
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City | HOUSTON
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State | TX
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Zip | 77059-3641
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Country | US
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Telephone | 281-998-0901
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Fax | 281-998-0903
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Authorized Official
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Title or Position | CO-OWNER
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Name | KAMI GUERTIN
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Credential | PT
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Telephone | 281-881-4330
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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 | 1166408
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License Number State | TX
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