=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356566764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC INTERVENTION FOR KIDS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3355 CHERRY RIDGE ST #209
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-366-1575
-----------------------------------------------------
Fax | 210-366-1883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3355 CHERRY RIDGE ST #209
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-4815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-366-1575
-----------------------------------------------------
Fax | 210-366-1883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. KRISTINA LOU MURRAY-INCLAN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 210-366-1575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number | 1021186
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------