Healthcare Provider Details

I. General information

NPI: 1255612412
Provider Name (Legal Business Name): MAGICAL KIDS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 JAIME ZAPATA MEMORIAL HWY STE 1 & 2
LAREDO TX
78043-4769
US

IV. Provider business mailing address

3507 JAIME ZAPATA MEMORIAL HWY STE 1 & 2
LAREDO TX
78043-4769
US

V. Phone/Fax

Practice location:
  • Phone: 956-753-6355
  • Fax: 956-753-6331
Mailing address:
  • Phone: 956-753-6355
  • Fax: 956-753-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH G. TREVINO
Title or Position: OWNER
Credential:
Phone: 956-753-6355