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General NPI Number Information
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NPI Number | 1912294380
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Entity Type | Organization
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Legal Business Name | CYPRESS CREEK PHYSICIAN MANAGEMENT
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 847 FM 1960 RD W SUITE 100A
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City | HOUSTON
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State | TX
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Zip | 77090-3403
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Country | US
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Telephone | 281-453-7916
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Fax | 281-440-2020
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Provider Business Mailing Address
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Address Line | 847 FM 1960 RD W SUITE 100A
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City | HOUSTON
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State | TX
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Zip | 77090-3403
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Country | US
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Telephone | 281-453-7916
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Fax | 281-440-2020
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STACY WILLIAMS
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Credential |
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Telephone | 281-453-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | TX
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