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General NPI Number Information
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NPI Number | 1265650329
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Entity Type | Organization
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Legal Business Name | JOURNEY PEDIATRIC REHABILITATION
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2100 W NORTHWEST HWY SUITE 202
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City | GRAPEVINE
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State | TX
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Zip | 76051-7808
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Country | US
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Telephone | 817-416-9797
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Fax | 817-416-9714
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Provider Business Mailing Address
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Address Line | 2100 W NORTHWEST HWY SUITE 202
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City | GRAPEVINE
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State | TX
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Zip | 76051-7808
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Country | US
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Telephone | 817-416-9797
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Fax | 817-416-9714
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY KATHERINE VILLARREAL
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Credential | OTR
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Telephone | 817-416-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 105728
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State | TX
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