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General NPI Number Information
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NPI Number | 1649801283
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Entity Type | Organization
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Legal Business Name | AMAZING REC THERAPY, LLC
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Dates
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Enumeration Date | 02/02/2020
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 4830 WILSON RD STE 300-1027
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City | HUMBLE
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State | TX
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Zip | 77396-1971
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Country | US
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Telephone | 619-415-9462
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Fax |
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Provider Business Mailing Address
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Address Line | 4830 WILSON RD STE 300-1027
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City | HUMBLE
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State | TX
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Zip | 77396-1971
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Country | US
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Telephone | 281-819-2015
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MISS REQUEL PACE
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Credential | MS, CTRS
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Telephone | 281-819-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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