| NPI | 1477714954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PLESHETTE BOUVIER JOHNSON Owner 281-412-7483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X (Licence: TX 9316) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K9516) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX K9516) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2008-06-18 |