Provider Demographics
NPI:1003130667
Name:THERAPY LANE PEDIATRIC REHABILITATION
Entity Type:Organization
Organization Name:THERAPY LANE PEDIATRIC REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CLOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:956-729-7555
Mailing Address - Street 1:2110 LOMAS DEL SUR
Mailing Address - Street 2:STE. 114
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5750
Mailing Address - Country:US
Mailing Address - Phone:956-729-7555
Mailing Address - Fax:956-729-7886
Practice Address - Street 1:2110 LOMAS DEL SUR
Practice Address - Street 2:STE. 114
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5750
Practice Address - Country:US
Practice Address - Phone:956-729-7555
Practice Address - Fax:956-729-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102934261QR0400X
TX103450261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation