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General NPI Number Information
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NPI Number | 1073991964
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Entity Type | Organization
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Legal Business Name | HULLABALOO PEDIATRIC THERAPY PLLC
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 01/15/2016
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Provider Practice Location Address
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Address Line | 2035 CROCKETT RD
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City | PALESTINE
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State | TX
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Zip | 75801-5921
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Country | US
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Telephone | 903-723-3602
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Fax | 903-731-9573
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Provider Business Mailing Address
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Address Line | 311 GLENWOOD DR.
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City | PALESTINE
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State | TX
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Zip | 75801
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Country | US
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Telephone | 903-391-8170
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KRISTI L. GRIMSLEY
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Credential | PT
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Telephone | 903-391-8170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1099075
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 108561
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 1099075
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License Number State | TX
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