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General NPI Number Information
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NPI Number | 1700338258
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Entity Type | Organization
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Legal Business Name | INFINITY & BEYOND THERAPY
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 12412 FM 2854 RD
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City | CONROE
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State | TX
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Zip | 77304-4426
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Country | US
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Telephone | 936-588-0005
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Fax | 936-588-1908
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Provider Business Mailing Address
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Address Line | 12412 FM 2854 RD
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City | CONROE
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State | TX
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Zip | 77304-4426
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Country | US
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Telephone | 936-588-0005
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Fax | 936-588-1908
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Authorized Official
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Title or Position | OWNER
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Name | DANITA R TREES
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Credential | PT
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Telephone | 936-588-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 110751
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License Number State | TX
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