NPIMap

Organization Active NPI

Brazosport Rehabilitation & Wellness, LLC

  • Physical Therapist
  • Lake Jackson, TX
National Provider Identifier
1013176783
Registry record updated Feb 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
662630000 Issued in TX
Legal business name
BRAZOSPORT REHABILITATION & WELLNESS, LLC
Practice address
321 Garland Dr
Lake Jackson, TX 77566
Phone
(979) 297-3365
Fax
(979) 297-3541
NPI assigned
Jun 6, 2008
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Drew R. Holt
Title
Coo
Phone
(979) 297-3365

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080818000103 TX Part B Supplier - Clinic/Group Practice 5496820029 Receives reassigned benefits from 5 practitioners
Practice locations: Lake Jackson, TX

National Provider Directory

National Provider Directory

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 662630000 TX Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

NPPES NPI Registry

Primary practice location

321 Garland Dr
Lake Jackson, TX 77566

Mailing address

321 Garland Dr
Lake Jackson, TX 77566
Phone (979) 297-3365

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 24, 2010.

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266969600000",
    "number": "1013176783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 GARLAND DR",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "77566",
            "telephone_number": "979-297-3365",
            "fax_number": "979-297-3541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 GARLAND DR",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "77566",
            "telephone_number": "979-297-3365",
            "fax_number": "979-297-3541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAZOSPORT REHABILITATION & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-06",
        "last_updated": "2010-02-24",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "DREW",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "979-297-3365",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "662630000",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Jackson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.