MEDICARE: BELTWAY WELLNESS CENTER

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	208100000X	Physical Medicine & Rehabilitation Physician	G7864	TX

General Provider Information

NPI Number	:	1689850125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELTWAY WELLNESS CENTER

Provider Business Mailing Address
First Line	:	14455 CULLEN BLVD
Second Line	:	C-2
City	:	HOUSTON
State	:	TX
Zip	:	77047-4800
Country	:	US
Telephone Number	:	713-734-0700
Fax Number	:	713-734-2394

Provider Business Practice Location Address
First Line	:	14455 CULLEN BLVD
Second Line	:	C-2
City	:	HOUSTON
State	:	TX
Zip	:	77047-4800
Country	:	US
Telephone Number	:	713-734-0700
Fax Number	:	713-734-2394

Authorized Official
Title or Position	:	REPRESENTATIVE
Name	:	DR. PLESHETTE BOUVIER JOHNSON
Credential	:	D.C.
Telephone Number	:	713-734-0700

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	07/17/2008

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Directions to “BELTWAY WELLNESS CENTER ” Practice Location

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