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General NPI Number Information
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NPI Number | 1215361720
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Entity Type | Organization
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Legal Business Name | RANCHO EL CHARCO THERAPY CENTER
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 100 N KIKA DE LA GARZA
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City | LA JOY
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State | TX
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Zip | 78560
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Country | US
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Telephone | 956-581-0395
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Fax | 956-584-9488
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Provider Business Mailing Address
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Address Line | 100 N KIKA DE LA GARZA
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City | LA JOY
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State | TX
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Zip | 78560
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Country | US
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Telephone | 956-581-0395
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Fax | 956-584-9488
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AUDREY ALVIZO
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Credential |
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Telephone | 956-521-9258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 104096
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License Number State | TX
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