=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902279383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE PEOPLE MOVER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2015
-----------------------------------------------------
Last Update Date | 11/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2810 POLK ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77003-4539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-858-3980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2810 POLK ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77003-4539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-858-3980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | CRYSTALYN R RICHARD
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 832-858-3980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------