Provider Demographics
NPI:1053318840
Name:ADVANCED FUNCTIONAL ASSESSMENTS INC
Entity type:Organization
Organization Name:ADVANCED FUNCTIONAL ASSESSMENTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:713-943-1100
Mailing Address - Street 1:3333 BAYSHORE BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1952
Mailing Address - Country:US
Mailing Address - Phone:713-943-1100
Mailing Address - Fax:713-943-1178
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1952
Practice Address - Country:US
Practice Address - Phone:713-943-1100
Practice Address - Fax:713-943-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7683311OtherAETNA
TX0019HCOtherBLUE CROSS BLUE SHIELD
TX00511TMedicare ID - Type UnspecifiedCLINIC GROUP NUMBER