Provider Demographics
NPI:1871760496
Name:HIXON, LARRY JOE (PT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JOE
Last Name:HIXON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19107 CRAIGCHESTER
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388
Mailing Address - Country:US
Mailing Address - Phone:281-353-5696
Mailing Address - Fax:
Practice Address - Street 1:25216 GROGANS PARK DR
Practice Address - Street 2:SUITE 206
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2175
Practice Address - Country:US
Practice Address - Phone:281-357-5454
Practice Address - Fax:281-357-5499
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K7654Medicare PIN