MEDICARE: CENTER FOR BALANCE & NEUROLOGICAL PHYSICAL THERAPY LLC

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	2251N0400X	Neurology Physical Therapist	1159888	TX
2	2251N0400X	Neurology Physical Therapist	1113769	TX
3	2251N0400X	Neurology Physical Therapist	1167260	TX
4	225XN1300X	Neurorehabilitation Occupational Therapist	107939	TX
5	225100000X	Physical Therapist	1144210	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC1391	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T3395	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1457302697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR BALANCE & NEUROLOGICAL PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	4141 SOUTHWEST FWY
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77027-7313
Country	:	US
Telephone Number	:	713-669-0042
Fax Number	:	713-223-1801

Provider Business Practice Location Address
First Line	:	4141 SOUTHWEST FWY
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77027-7313
Country	:	US
Telephone Number	:	713-669-0042
Fax Number	:	713-223-1801

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. DEBBIE K LEE
Credential	:	PT
Telephone Number	:	713-669-0042

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	02/11/2011

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Directions to “CENTER FOR BALANCE & NEUROLOGICAL PHYSICAL THERAPY LLC ” Practice Location

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