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General NPI Number Information
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NPI Number | 1629495205
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Entity Type | Organization
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Legal Business Name | R.O.C.K RIDE ON CENTER FOR KIDS
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 2050 ROCKRIDE LANE
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City | GEORGETOWN
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State | TX
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Zip | 78627
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Country | US
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Telephone | 512-930-7625
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Fax | 512-863-9231
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Provider Business Mailing Address
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Address Line | PO BOX 2422
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City | GEORGETOWN
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State | TX
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Zip | 78627-2422
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Country | US
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Telephone | 512-930-7625
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Fax | 512-863-9231
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Authorized Official
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Title or Position | C.E.O
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Name | MRS. NANCY RIDE ON CENTER KRENCK
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Credential |
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Telephone | 512-930-7625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 642120000
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License Number State | TX
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