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General NPI Number Information
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NPI Number | 1073767497
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Entity Type | Organization
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Legal Business Name | HARBOR RECREATION LLC
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 2460 CREEKWOOD DR
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City | CEDAR HILL
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State | TX
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Zip | 75104
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Country | US
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Telephone | 972-841-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 445 E FM 1382 STE 3 PMB 351
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City | CEDAR HILL
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State | TX
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Zip | 75104
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Country | US
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Telephone | 972-841-2165
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Fax | 972-293-1712
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CYNTHIA ANN PITTMAN
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Credential | CTRS
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Telephone | 972-841-2165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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