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General NPI Number Information
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NPI Number | 1760719991
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Entity Type | Organization
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Legal Business Name | IMPACT THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 11/09/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 1025 N TEXAS BLVD STE 21I
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City | WESLACO
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State | TX
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Zip | 78596-4557
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Country | US
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Telephone | 956-969-2160
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Fax | 956-973-0208
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Provider Business Mailing Address
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Address Line | PO BOX 1899
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City | WESLACO
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State | TX
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Zip | 78599-1899
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Country | US
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Telephone | 956-969-2160
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Fax | 956-973-0208
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Authorized Official
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Title or Position | OWNER
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Name | CLAUDIA HERNANDEZ GOMEZ
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Credential | M.S., CCC-SLP
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Telephone | 956-969-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 112606
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 40186
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License Number State | TX
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