MEDICARE: LAREDO KIDS ADVANCED THERAPY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1295076503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAREDO KIDS ADVANCED THERAPY INC.

Provider Business Mailing Address
First Line	:	4609 SAN DARIO AVE
Second Line	:	SUITE 9
City	:	LAREDO
State	:	TX
Zip	:	78041-5773
Country	:	US
Telephone Number	:	956-723-6600
Fax Number	:	956-723-6614

Provider Business Practice Location Address
First Line	:	4609 SAN DARIO AVE
Second Line	:	SUITE 9
City	:	LAREDO
State	:	TX
Zip	:	78041-5773
Country	:	US
Telephone Number	:	956-723-6600
Fax Number	:	956-723-6614

Authorized Official
Title or Position	:	HUMAN RESOURCES DIRECTOR
Name	:	SARAI VASQUEZ
Credential	:
Telephone Number	:	956-723-6600

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	03/12/2013

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