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General NPI Number Information
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NPI Number | 1902119092
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Entity Type | Organization
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Legal Business Name | MUSTARD SEEDS THERAPY, INC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 5014 OAK BEND CIR
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City | DENTON
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State | TX
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Zip | 76208-3418
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Country | US
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Telephone | 817-709-9031
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | JUSTIN
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State | TX
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Zip | 76247-0114
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Country | US
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Telephone | 817-709-9031
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. WAEL KANAN
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Credential |
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Telephone | 817-709-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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