Provider Demographics
NPI:1548550593
Name:PHYSICAL AND ACADEMIC LEARNING SERVICES, PLLC
Entity type:Organization
Organization Name:PHYSICAL AND ACADEMIC LEARNING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/OTD
Authorized Official - Phone:979-732-7021
Mailing Address - Street 1:1370 FRELSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ALLEYTON
Mailing Address - State:TX
Mailing Address - Zip Code:78935-2037
Mailing Address - Country:US
Mailing Address - Phone:979-732-7021
Mailing Address - Fax:979-733-9939
Practice Address - Street 1:1370 FRELSBURG RD
Practice Address - Street 2:
Practice Address - City:ALLEYTON
Practice Address - State:TX
Practice Address - Zip Code:78935-2037
Practice Address - Country:US
Practice Address - Phone:979-732-7021
Practice Address - Fax:979-733-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553430000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1797078-01Medicaid