Provider Demographics
NPI:1154739589
Name:BUBBLES PEDIATRIC THERAPY
Entity type:Organization
Organization Name:BUBBLES PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:LOPE
Authorized Official - Last Name:LIVESON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MOT
Authorized Official - Phone:956-724-5448
Mailing Address - Street 1:2100 CORPUS CHRISTI ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-3398
Mailing Address - Country:US
Mailing Address - Phone:956-724-5448
Mailing Address - Fax:956-724-5449
Practice Address - Street 1:2100 CORPUS CHRISTI ST
Practice Address - Street 2:SUITE 14
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-3398
Practice Address - Country:US
Practice Address - Phone:956-724-5448
Practice Address - Fax:956-724-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty