Provider Demographics
NPI:1013202936
Name:MCL HOME THERAPY, LLC
Entity Type:Organization
Organization Name:MCL HOME THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISATRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE MARIE
Authorized Official - Middle Name:SUAREZ
Authorized Official - Last Name:AZCONA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:832-260-2227
Mailing Address - Street 1:13107 ADVANCE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-2103
Mailing Address - Country:US
Mailing Address - Phone:832-260-2227
Mailing Address - Fax:832-688-8832
Practice Address - Street 1:13107 ADVANCE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-2103
Practice Address - Country:US
Practice Address - Phone:832-260-2227
Practice Address - Fax:832-688-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty