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General NPI Number Information
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NPI Number | 1922740075
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Entity Type | Organization
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Legal Business Name | DIRECT PT OF HUNTSVILLE TX
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 3200 ROBINSON CREEK PKWY STE B
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City | HUNTSVILLE
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State | TX
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Zip | 77340-2298
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Country | US
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Telephone | 936-994-8752
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Fax |
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Provider Business Mailing Address
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Address Line | 810 PINEDALE RD
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City | HUNTSVILLE
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State | TX
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Zip | 77320-7441
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Country | US
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Telephone | 936-994-8752
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE MBR
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Name | CASSIE FRY
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Credential |
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Telephone | 936-994-8752
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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 |
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License Number State |
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