Provider Demographics
NPI:1053683177
Name:BLAST-OFF THERAPY CENTER, PLLC
Entity Type:Organization
Organization Name:BLAST-OFF THERAPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-0279
Mailing Address - Street 1:38615 MILE 7 RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-8474
Mailing Address - Country:US
Mailing Address - Phone:956-583-0279
Mailing Address - Fax:956-583-0706
Practice Address - Street 1:38615 MILE 7 RD UNIT 4
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8474
Practice Address - Country:US
Practice Address - Phone:956-583-0279
Practice Address - Fax:956-583-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-05
Last Update Date:2012-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112204225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty