MEDICARE: FROM THE HEART PEDIATRIC 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1356770713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FROM THE HEART PEDIATRIC THERAPY INC

Provider Business Mailing Address
First Line	:	15222 ELM PARK ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-2902
Country	:	US
Telephone Number	:	210-326-8172
Fax Number	:

Provider Business Practice Location Address
First Line	:	15222 ELM PARK ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-2902
Country	:	US
Telephone Number	:	210-326-8172
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELLI DENISE GIBBONS
Credential	:
Telephone Number	:	210-326-8172

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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