Healthcare Provider Details

I. General information

NPI: 1588295737
Provider Name (Legal Business Name): ROOTS MUSIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12207 MELON ST
SAN ANTONIO TX
78247-4322
US

IV. Provider business mailing address

12207 MELON ST
SAN ANTONIO TX
78247-4322
US

V. Phone/Fax

Practice location:
  • Phone: 210-818-1174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGAN CRANDALL
Title or Position: FOUNDER & CEO
Credential: MA, MT-BC
Phone: 210-818-1174