Provider Demographics
NPI:1194120345
Name:SHUTTLE THERAPY LLC
Entity type:Organization
Organization Name:SHUTTLE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MANAGING MEMBER
Authorized Official - Phone:956-800-5038
Mailing Address - Street 1:120 N SUGAR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-3619
Mailing Address - Country:US
Mailing Address - Phone:956-800-5038
Mailing Address - Fax:956-800-5038
Practice Address - Street 1:120 N SUGAR RD
Practice Address - Street 2:SUITE B
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-3619
Practice Address - Country:US
Practice Address - Phone:956-800-5038
Practice Address - Fax:956-800-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty