Provider Demographics
NPI:1598013658
Name:A DIFFERENT KIND OF PERFECT PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:A DIFFERENT KIND OF PERFECT PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-341-1132
Mailing Address - Street 1:1555 W. HWY. 380
Mailing Address - Street 2:SUITE #2
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-5542
Mailing Address - Country:US
Mailing Address - Phone:817-823-9077
Mailing Address - Fax:
Practice Address - Street 1:1555 W. HWY. 380
Practice Address - Street 2:SUITE #2
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-5542
Practice Address - Country:US
Practice Address - Phone:817-823-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3272809-01Medicaid