MEDICARE: WEEKEND PHYSICAL THERAPY, P.C.

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	666070000	TX

General Provider Information

NPI Number	:	1437386240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEEKEND PHYSICAL THERAPY, P.C.

Provider Business Mailing Address
First Line	:	4219 RICHMOND AVE STE 110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6838
Country	:	US
Telephone Number	:	713-621-2489
Fax Number	:	713-621-2491

Provider Business Practice Location Address
First Line	:	4219 RICHMOND AVE STE 110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6838
Country	:	US
Telephone Number	:	713-621-2489
Fax Number	:	713-621-2491

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAURIE G. JOHNSON
Credential	:	P.T.
Telephone Number	:	713-621-2489

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/18/2009

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