MEDICARE: BUSYBODY FITNESS & REHAB, PLLC

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	1221275	TX
2	2251C2600X	Cardiopulmonary Physical Therapist	1221275	TX
3	2251G0304X	Geriatric Physical Therapist	1221275	TX
4	2251P0200X	Pediatric Physical Therapist	1221275	TX
5	2251S0007X	Sports Physical Therapist	1221275	TX
6	261Q00000X	Clinic/Center	1221275	TX
7	305R00000X	Preferred Provider Organization	1221275	TX
8	2251X0800X	Orthopedic Physical Therapist	1221275	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679017776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUSYBODY FITNESS & REHAB, PLLC

Provider Business Mailing Address
First Line	:	2323 S VOSS RD STE 390
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3809
Country	:	US
Telephone Number	:	832-584-9657
Fax Number	:	832-827-4255

Provider Business Practice Location Address
First Line	:	2323 S VOSS RD STE 390
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3809
Country	:	US
Telephone Number	:	832-584-9657
Fax Number	:	832-827-4255

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. CHINETRA COOK
Credential	:	PT, DPT, CERT. DN
Telephone Number	:	832-584-9657

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	06/11/2019

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