Provider Demographics
NPI:1437602927
Name:PT FOR KIDS
Entity Type:Organization
Organization Name:PT FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WATCHARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-582-9104
Mailing Address - Street 1:5009 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5732
Mailing Address - Country:US
Mailing Address - Phone:832-465-1903
Mailing Address - Fax:713-663-7522
Practice Address - Street 1:5009 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-5732
Practice Address - Country:US
Practice Address - Phone:832-465-1903
Practice Address - Fax:713-663-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198498101Medicaid