MEDICARE: EVERGREEN PHYSICAL THERAPY LIMITED PARTNERSHIP

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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1962515809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN PHYSICAL THERAPY LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	1300 W SAM HOUSTON PKWY S
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77042-2447
Country	:	US
Telephone Number	:	713-297-7000
Fax Number	:	713-297-7090

Provider Business Practice Location Address
First Line	:	158 NORTH FIRST STREET
Second Line	:	SUITE D
City	:	HARRISON
State	:	MI
Zip	:	48625
Country	:	US
Telephone Number	:	989-539-4167
Fax Number	:	989-539-4436

Authorized Official
Title or Position	:	VP, AUTHORIZED OFFICIAL
Name	:	JANNA P. KING
Credential	:	JD
Telephone Number	:	713-297-7000

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	09/11/2025

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