NPIMap

Organization Active NPI

Tx770911-002, LLC

Doing business as Legend Physical Therapy - Clearlake

  • Physical Therapist
  • Houston, TX
National Provider Identifier
1629356761
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1190830 Issued in TX
Legal business name
TX770911-002, LLC
Doing business as
Legend Physical Therapy - Clearlake
Practice address
1117 Clear LK Cty Blvd
Houston, TX 77062-8102
Phone
(281) 401-9789
Fax
(281) 401-9779
NPI assigned
Jul 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas Martin Tomerlin
Title
Owner
Phone
(210) 564-0100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CHIA-1275 ID
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 1190830 TX Primary

Addresses

Primary practice location

1117 Clear LK Cty Blvd
Houston, TX 77062-8102

Mailing address

608 Sandau Rd
San Antonio, TX 78216-4131
Phone (210) 564-0100

Other names 1

  • Legend Physical Therapy - Clearlake Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1629356761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 SANDAU RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164131",
            "telephone_number": "210-564-0100",
            "fax_number": "210-564-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 CLEAR LK CTY BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770628102",
            "telephone_number": "281-401-9789",
            "fax_number": "281-401-9779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TX770911-002, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-22",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "TOMERLIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-564-0100"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "ID",
            "license": "CHIA-1275",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1190830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legend Physical Therapy - Clearlake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.