Provider Demographics
NPI:1659658284
Name:JDM DIRECT INTERVENTION PLLC
Entity Type:Organization
Organization Name:JDM DIRECT INTERVENTION PLLC
Other - Org Name:FUNTASTIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:956-718-2020
Mailing Address - Street 1:10809 MARFA RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8686
Mailing Address - Country:US
Mailing Address - Phone:956-718-2020
Mailing Address - Fax:956-718-2919
Practice Address - Street 1:1501 E BUSTAMANTE ST
Practice Address - Street 2:STE. G
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-8905
Practice Address - Country:US
Practice Address - Phone:956-718-2020
Practice Address - Fax:956-718-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation