Provider Demographics
NPI:1336479856
Name:BIG SKY PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:BIG SKY PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:ODT, OTR
Authorized Official - Phone:512-306-8007
Mailing Address - Street 1:925 WESTBANK DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6621
Mailing Address - Country:US
Mailing Address - Phone:512-306-8007
Mailing Address - Fax:512-672-6178
Practice Address - Street 1:925 WESTBANK DR
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6621
Practice Address - Country:US
Practice Address - Phone:512-306-8007
Practice Address - Fax:512-672-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104164261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy