Provider Demographics
NPI:1568929511
Name:COMMONWEALTH THERAPY COMPANY LLC
Entity type:Organization
Organization Name:COMMONWEALTH THERAPY COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:O'DOHERTY
Authorized Official - Last Name:DI VINCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:541-771-0163
Mailing Address - Street 1:428 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6705
Mailing Address - Country:US
Mailing Address - Phone:703-718-6603
Mailing Address - Fax:
Practice Address - Street 1:820 S. MACARTHUR BLVD STE 105 - 149
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-1171
Practice Address - Country:US
Practice Address - Phone:703-718-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty