MEDICARE: IMPACT CARE THERAPY

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

General Provider Information

NPI Number	:	1396206793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPACT CARE THERAPY

Provider Business Mailing Address
First Line	:	3841 CARTWRIGHT RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2443
Country	:	US
Telephone Number	:	832-322-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 CARTWRIGHT RD
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2443
Country	:	US
Telephone Number	:	832-303-2215
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMANUEL MUGU MIANO
Credential	:	PT, DPT, NCS
Telephone Number	:	346-341-7307

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	07/02/2019

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Directions to “IMPACT CARE THERAPY ” Practice Location

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