MEDICARE: THE WOODLANDS AQUATIC & LAND 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		TX

General Provider Information

NPI Number	:	1518970276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WOODLANDS AQUATIC & LAND THERAPY

Provider Business Mailing Address
First Line	:	395 SAWDUST RD
Second Line	:	PMB 2033
City	:	WOODLANDS
State	:	TX
Zip	:	77380
Country	:	US
Telephone Number	:	281-646-1935
Fax Number	:	281-646-0927

Provider Business Practice Location Address
First Line	:	25003 PITKIN RD
Second Line	:	STE E 100
City	:	WOODLANDS
State	:	TX
Zip	:	77386
Country	:	US
Telephone Number	:	281-367-0011
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	MS. KELLY R KENDRA
Credential	:	PT
Telephone Number	:	281-646-1935

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/22/2020

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Directions to “THE WOODLANDS AQUATIC & LAND THERAPY ” Practice Location

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