Provider Demographics
NPI:1053460972
Name:ASPIRE PEDIATRIC THERAPY AND REHAB INC
Entity Type:Organization
Organization Name:ASPIRE PEDIATRIC THERAPY AND REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-364-9161
Mailing Address - Street 1:4840 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3527
Mailing Address - Country:US
Mailing Address - Phone:281-681-3020
Mailing Address - Fax:281-298-9905
Practice Address - Street 1:4840 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 206
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3527
Practice Address - Country:US
Practice Address - Phone:281-681-3020
Practice Address - Fax:281-298-9905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00695WMedicare ID - Type Unspecified