Provider Demographics
NPI:1861141749
Name:FIXIO PHYSICAL THERAPY & RECOVERY CLINIC
Entity type:Organization
Organization Name:FIXIO PHYSICAL THERAPY & RECOVERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEDIDIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-379-0668
Mailing Address - Street 1:12602 CARLISLE FALLS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1594
Mailing Address - Country:US
Mailing Address - Phone:832-379-0668
Mailing Address - Fax:
Practice Address - Street 1:4102 VETERANS DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2950
Practice Address - Country:US
Practice Address - Phone:832-379-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty