1750603502 NPI number — RECREATIONAL THERAPY OF TEXAS LLC

Table of content: (NPI 1750603502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750603502 NPI number — RECREATIONAL THERAPY OF TEXAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECREATIONAL THERAPY OF TEXAS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750603502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 592321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-892-1841
Provider Business Mailing Address Fax Number:
888-892-1839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 GATEWAY BLVD
Provider Second Line Business Practice Location Address:
# 224
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-2671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-892-1841
Provider Business Practice Location Address Fax Number:
888-892-1839
Provider Enumeration Date:
02/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
888-892-1841

Provider Taxonomy Codes

  • Taxonomy code: 225800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com