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General NPI Number Information
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NPI Number | 1295529709
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Entity Type | Organization
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Legal Business Name | ROOTED PEDIATRIC THERAPY PLLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 9525 W AMARILLO BLVD STE B
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City | AMARILLO
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State | TX
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Zip | 79124-2329
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Country | US
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Telephone | 806-452-9765
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Fax |
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Provider Business Mailing Address
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Address Line | 7728 BAUGHMAN DR
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City | AMARILLO
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State | TX
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Zip | 79121-1752
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Country | US
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Telephone | 806-452-9765
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAUREN GAMBLE
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Credential | M.S., CCC-SLP. CLC
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Telephone | 806-452-9765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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