Basic Information
| Provider Information | |||||||||
| NPI: | 1306241724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICUBO | ||||||||
| FirstName: | CHERRY PAI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9380 W SAM HOUSTON PKWY S STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770995222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323203174 | ||||||||
| FaxNumber: | 7138698637 | ||||||||
| Practice Location | |||||||||
| Address1: | 9380 W SAM HOUSTON PKWY S STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770995222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323203174 | ||||||||
| FaxNumber: | 7138698637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 009551 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2108857 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.