Provider Demographics
NPI:1629495205
Name:R.O.C.K RIDE ON CENTER FOR KIDS
Entity Type:Organization
Organization Name:R.O.C.K RIDE ON CENTER FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:RIDE ON CENTER
Authorized Official - Last Name:KRENCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-930-7625
Mailing Address - Street 1:PO BOX 2422
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-2422
Mailing Address - Country:US
Mailing Address - Phone:512-930-7625
Mailing Address - Fax:512-863-9231
Practice Address - Street 1:2050 ROCKRIDE LANE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78627
Practice Address - Country:US
Practice Address - Phone:512-930-7625
Practice Address - Fax:512-863-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642120000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty