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General NPI Number Information
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NPI Number | 1427696178
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY, INC.
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 4601 66TH ST STE D
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City | LUBBOCK
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State | TX
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Zip | 79414-4875
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Country | US
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Telephone | 866-832-1708
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Fax | 888-798-4391
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Provider Business Mailing Address
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Address Line | 9011 MOUNTAIN RIDGE DR STE 130
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City | AUSTIN
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State | TX
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Zip | 78759-7394
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Country | US
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Telephone | 855-268-4098
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Fax | 866-311-9885
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERARATIONS
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Name | JAMES M CLARK
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Credential |
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Telephone | 866-832-1708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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