Healthcare Provider Details

I. General information

NPI: 1386776763
Provider Name (Legal Business Name): GROWING PLACES THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESTFALIAN TRL
AUSTIN TX
78732-1967
US

IV. Provider business mailing address

2100 WESTFALIAN TRL
AUSTIN TX
78732-1967
US

V. Phone/Fax

Practice location:
  • Phone: 512-587-5671
  • Fax: 512-535-6786
Mailing address:
  • Phone: 512-587-5671
  • Fax: 512-535-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1118164
License Number StateTX

VIII. Authorized Official

Name: MISS DOUG C LEVINE
Title or Position: CO-OWNER
Credential: MSPT
Phone: 512-587-5671