MEDICARE: PHYSICAL WELLNESS CENTER

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1366991002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL WELLNESS CENTER

Provider Business Mailing Address
First Line	:	14614 FALLING CREEK DR STE 217
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-2941
Country	:	US
Telephone Number	:	832-699-8000
Fax Number	:	281-506-2995

Provider Business Practice Location Address
First Line	:	14614 FALLING CREEK DR STE 217
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-2941
Country	:	US
Telephone Number	:	832-699-8000
Fax Number	:	281-506-2995

Authorized Official
Title or Position	:	OWNER/SOLE MEMBER
Name	:	MR. PATRICK MONTOYA
Credential	:
Telephone Number	:	713-259-3832

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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Directions to “PHYSICAL WELLNESS CENTER ” Practice Location

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