MEDICARE: KOALA HEALTH & WELLNESS TESTING & PERFORMANCE CENTERS, LP

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	F006339	TX
2	225100000X	Physical Therapist		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0035MU	OTHER	TX	BCBS GROUP ID

General Provider Information

NPI Number	:	1659497360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOALA HEALTH & WELLNESS TESTING & PERFORMANCE CENTERS, LP

Provider Business Mailing Address
First Line	:	PO BOX 890389
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77289-0389
Country	:	US
Telephone Number	:	281-286-8520
Fax Number	:	281-286-2947

Provider Business Practice Location Address
First Line	:	2626 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1606
Country	:	US
Telephone Number	:	713-463-9111
Fax Number	:	713-329-9126

Authorized Official
Title or Position	:	OWNER
Name	:	MARY DOYLE
Credential	:
Telephone Number	:	713-463-9111

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/11/2025

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