Provider Demographics
NPI:1356655666
Name:EZ PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:EZ PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LA SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP- ASSISTANT
Authorized Official - Phone:832-289-5663
Mailing Address - Street 1:11711 SHADOW CREEK PKWY STE 113
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7233
Mailing Address - Country:US
Mailing Address - Phone:832-289-5663
Mailing Address - Fax:
Practice Address - Street 1:5505 W OREM DR
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1276
Practice Address - Country:US
Practice Address - Phone:832-289-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331532355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty