Provider Demographics
NPI:1194446914
Name:GARZA THERAPEUTIC PLAY INC
Entity type:Organization
Organization Name:GARZA THERAPEUTIC PLAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-731-6795
Mailing Address - Street 1:4819 S LAMON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2122
Mailing Address - Country:US
Mailing Address - Phone:312-731-6795
Mailing Address - Fax:312-276-4255
Practice Address - Street 1:4819 S LAMON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2122
Practice Address - Country:US
Practice Address - Phone:312-731-6795
Practice Address - Fax:312-276-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty