MEDICARE: GIGGLES THERAPY, LLC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1417131137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIGGLES THERAPY, LLC

Provider Business Mailing Address
First Line	:	905 ROBERTS CUT OFF RD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	817-731-2293
Fax Number	:	817-731-2293

Provider Business Practice Location Address
First Line	:	905 ROBERTS CUT OFF RD
Second Line	:
City	:	RIVER OAKS
State	:	TX
Zip	:	76114-2825
Country	:	US
Telephone Number	:	817-731-2293
Fax Number	:	817-731-2293

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	COURTNEY BOGGS
Credential	:
Telephone Number	:	817-565-4052

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/18/2007

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