MEDICARE: FUN 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	261QP2000X	Physical Therapy Clinic/Center	658540000	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6584000	OTHER	TX	PHYSICAL THERAPY

General Provider Information

NPI Number	:	1760676167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUN THERAPY, LLC

Provider Business Mailing Address
First Line	:	7108 N. CYNTHIA ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504
Country	:	US
Telephone Number	:	956-227-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 BUSINESS PARK DR
Second Line	:	SUITE B
City	:	MISSION
State	:	TX
Zip	:	78572-6052
Country	:	US
Telephone Number	:	956-227-4200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CELIA T OJEAGA
Credential	:
Telephone Number	:	956-227-4200

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	05/26/2009

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Directions to “FUN THERAPY, LLC ” Practice Location

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