Provider Demographics
NPI:1639542806
Name:JB KIDS THERAPY LLC
Entity Type:Organization
Organization Name:JB KIDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:915-491-3823
Mailing Address - Street 1:12401 PASEO ALEGRE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:915-855-8877
Practice Address - Street 1:2030 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3414
Practice Address - Country:US
Practice Address - Phone:915-533-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty