Basic Information
| Provider Information | |||||||||
| NPI: | 1891129607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINDHAM | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20403 UNIVERSITY BLVD. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813250188 | ||||||||
| FaxNumber: | 2813250189 | ||||||||
| Practice Location | |||||||||
| Address1: | 20403 UNIVERSITY BLVD. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813250188 | ||||||||
| FaxNumber: | 2813250189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2013 | ||||||||
| LastUpdateDate: | 08/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1232711 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.