Healthcare Provider Details

I. General information

NPI: 1306686670
Provider Name (Legal Business Name): SKY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 NEW MATHIS RD STE 104
ELMENDORF TX
78112-6276
US

IV. Provider business mailing address

3712 NEW MATHIS RD STE 104
ELMENDORF TX
78112-6276
US

V. Phone/Fax

Practice location:
  • Phone: 956-473-9897
  • Fax:
Mailing address:
  • Phone: 210-757-3021
  • Fax: 210-783-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARIA TERESA TEJADA
Title or Position: COTA
Credential:
Phone: 956-473-9897