Provider Demographics
NPI:1366845711
Name:CENTER FOR PEDIATRIC THERAPY INC
Entity Type:Organization
Organization Name:CENTER FOR PEDIATRIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:281-292-4800
Mailing Address - Street 1:2721 N LOGRUN CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4010
Mailing Address - Country:US
Mailing Address - Phone:281-292-4800
Mailing Address - Fax:
Practice Address - Street 1:431 NURSERY RD STE A100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1918
Practice Address - Country:US
Practice Address - Phone:281-292-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12475022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1200834-05Medicaid