MEDICARE: MR. ANDREW O HYDE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3109080 TEMP	TX

General Provider Information

NPI Number	:	1265753628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW O HYDE DPT

Provider Business Mailing Address
First Line	:	2840 COMMERCIAL CENTER BLVD
Second Line	:	SUITE 103
City	:	KATY
State	:	TX
Zip	:	77494-6411
Country	:	US
Telephone Number	:	281-693-1063
Fax Number	:	281-693-1081

Provider Business Practice Location Address
First Line	:	2840 COMMERCIAL CENTER BLVD
Second Line	:	SUITE 103
City	:	KATY
State	:	TX
Zip	:	77494-6411
Country	:	US
Telephone Number	:	281-693-1063
Fax Number	:	281-693-1081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2010
Last Update Date	:	06/18/2010

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Directions to “ MR. ANDREW O HYDE DPT” Practice Location

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