Age Victoriously Llc is a medicare enrolled "Clinic/center - Physical Therapy" provider in Houston, Texas. Their current practice location is
7880 San Felipe St Ste 200, Houston, Texas. You can reach out to their office (for appointments etc.) via phone at
(832) 377-5968.
Age Victoriously Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Age Victoriously Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1518744861.
Healthcare Provider's Profile
| Full Name | Age Victoriously Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Physical Therapy |
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| Location | 7880 San Felipe St Ste 200, Houston, Texas |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1518744861
- Provider Enumeration Date: 09/11/2023
- Last Update Date: 09/11/2023
Medicare PECOS Information:
- PECOS PAC ID: 6709228778
- Enrollment ID: O20240522000660
Medical Identifiers
Medical identifiers for Age Victoriously Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1518744861 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2251G0304X | Physical Therapist - Geriatrics | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Age Victoriously Llc acts as a billing entity for following providers:
| Provider Name | Jeremy Bourgeois |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1548648884
PECOS PAC ID: 9133429327
Enrollment ID: I20151217000611 |
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| Provider Name | Emily C Morrel |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1013490796
PECOS PAC ID: 1254675424
Enrollment ID: I20181129001870 |
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| Provider Name | James Harvey |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1346811916
PECOS PAC ID: 9537566021
Enrollment ID: I20210927001233 |
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| Provider Name | Ayomide Fasalojo |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1033630561
PECOS PAC ID: 5294120333
Enrollment ID: I20220328000861 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Age Victoriously Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Age Victoriously Llc
2753 E Tamarisk St,
Gilbert, AZ 85296-8997
Ph: (602) 741-6739 | Age Victoriously Llc
7880 San Felipe St Ste 200,
Houston, TX 77063-1608
Ph: (832) 377-5968 |
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