Basic Information
| Provider Information | |||||||||
| NPI: | 1134205610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECTRUM PHYSICAL THERAPY LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 W SAM HOUSTON PKWY S | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770422447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132977000 | ||||||||
| FaxNumber: | 7132977090 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 STONINGTON RD | ||||||||
| Address2: | SUITE A-3 | ||||||||
| City: | MYSTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063552965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605361699 | ||||||||
| FaxNumber: | 8605361686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 03/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP,AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | JD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.