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General NPI Number Information
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NPI Number | 1699052811
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Entity Type | Organization
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Legal Business Name | TEXAS TECH THERAPEUTIC RIDING CENTER
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 5712 COUNTY ROAD 1500
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City | LUBBOCK
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State | TX
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Zip | 79407-5412
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Country | US
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Telephone | 806-785-2564
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Fax | 806-792-4683
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Provider Business Mailing Address
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Address Line | PO BOX 42141
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City | LUBBOCK
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State | TX
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Zip | 79409-2141
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Country | US
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Telephone | 806-785-2564
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Fax | 806-792-4683
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Authorized Official
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Title or Position | DIRECTOR
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Name | HEATHER HERNANDEZ
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Credential |
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Telephone | 806-785-2564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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