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General NPI Number Information
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NPI Number | 1164895595
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Entity Type | Organization
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Legal Business Name | STELLAR PEDIATRIC THERAPY, PLLC
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 225 W PIPELINE RD
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City | HURST
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State | TX
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Zip | 76053-5620
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Country | US
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Telephone | 817-438-2366
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W PIPELINE RD
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City | HURST
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State | TX
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Zip | 76053-5620
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Country | US
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Telephone | 817-438-2366
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MANAGER
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Name | RHONDA ROPER NAZZARO
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Credential | CCC-SLP
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Telephone | 817-438-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 100824
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License Number State | TX
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