Provider Demographics
NPI:1427376813
Name:THE KIDS SPOT PEDIATRIC REHAB
Entity Type:Organization
Organization Name:THE KIDS SPOT PEDIATRIC REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:VILLAREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-412-6060
Mailing Address - Street 1:512 VICTORIA LN
Mailing Address - Street 2:SUITE 13
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3226
Mailing Address - Country:US
Mailing Address - Phone:956-412-6060
Mailing Address - Fax:956-412-6070
Practice Address - Street 1:3675 BOCA CHICA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4483
Practice Address - Country:US
Practice Address - Phone:956-546-7800
Practice Address - Fax:956-546-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332282355S0801X
TX351472355S0801X
TX335362355S0801X
TX330242355S0801X
TX352902355S0801X
TX342962355S0801X
TX334782355S0801X
TX346882355S0801X
TX102914235Z00000X
TX102304235Z00000X
TX103454235Z00000X
TX17791235Z00000X
TX103021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty