Provider Demographics
NPI:1124461249
Name:RAD PEDIATRICS, PLLC
Entity type:Organization
Organization Name:RAD PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:713-444-7270
Mailing Address - Street 1:6 ROBIN SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3108
Mailing Address - Country:US
Mailing Address - Phone:713-444-7270
Mailing Address - Fax:
Practice Address - Street 1:4747 RESEARCH FOREST DR
Practice Address - Street 2:STE 180,# 115
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4912
Practice Address - Country:US
Practice Address - Phone:713-444-7270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198455102Medicaid