1912580515 NPI number — MOTIV8 PEDIATRIC THERAPY, LLC

Table of content: (NPI 1912580515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912580515 NPI number — MOTIV8 PEDIATRIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOTIV8 PEDIATRIC THERAPY, 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:
6
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:
1912580515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 W EDGEWOOD DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77546-4497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-998-0388
Provider Business Mailing Address Fax Number:
409-299-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6226 WATFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAGUE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77573-7152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-998-0388
Provider Business Practice Location Address Fax Number:
409-299-3131
Provider Enumeration Date:
04/30/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PADILLA MELENDEZ
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
NAHIR
Authorized Official Title or Position:
OTR, MANAGER
Authorized Official Telephone Number:
409-998-0388

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1902317183 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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