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Organization
TX770911-002, LLC
Active
Organization
TX770911-002, LLC
Active
Other names
Legend Physical Therapy - Clearlake
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MARTIN TOMERLIN (OWNER)
(210) 564-0100
Entity
Organization
Contact information
Practice address
1117 CLEAR LK CTY BLVD, HOUSTON, TX 77062-8102
(281) 401-9789
(281) 401-9779
Mailing address
608 SANDAU RD, SAN ANTONIO, TX 78216-4131
(210) 564-0100
(210) 564-0157
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
CHIA-1275
ID
225100000X
Physical Therapist
Primary
1190830
TX
Other
Enumeration date
07/22/2011
Last updated
09/07/2012
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