Healthcare Provider Details

I. General information

NPI: 1083710032
Provider Name (Legal Business Name): HEART OF TEXAS THERAPEUTIC RIDING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 E WHITE OAK RD
WEST TX
76691-1963
US

IV. Provider business mailing address

848 E WHITE OAK RD
WEST TX
76691-1963
US

V. Phone/Fax

Practice location:
  • Phone: 254-829-0674
  • Fax: 254-829-0474
Mailing address:
  • Phone: 254-829-0674
  • Fax: 254-829-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIRLEY KAY WILLS
Title or Position: DIRECTOR
Credential: ED.D.
Phone: 254-829-0674