Provider Demographics
NPI:1467932103
Name:CENTRAL TEXAS THERAPY SPOT PLLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS THERAPY SPOT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:210-213-4143
Mailing Address - Street 1:1420 HOOSIER PARK
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5695
Mailing Address - Country:US
Mailing Address - Phone:210-213-4143
Mailing Address - Fax:254-732-5922
Practice Address - Street 1:6801 SANGER AVE STE 105
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7807
Practice Address - Country:US
Practice Address - Phone:210-213-4143
Practice Address - Fax:254-732-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356796213Medicaid