Provider Demographics
NPI:1306236716
Name:FUN HOUSE PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:FUN HOUSE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:956-605-1516
Mailing Address - Street 1:1103 W ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-4424
Mailing Address - Country:US
Mailing Address - Phone:956-605-1516
Mailing Address - Fax:
Practice Address - Street 1:1103 W ACACIA AVE
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-4424
Practice Address - Country:US
Practice Address - Phone:956-605-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty