Provider Demographics
NPI:1679010631
Name:CREATIVE MOTION PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:CREATIVE MOTION PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-759-6500
Mailing Address - Street 1:5907 W MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-6011
Mailing Address - Country:US
Mailing Address - Phone:903-759-6500
Mailing Address - Fax:866-916-2178
Practice Address - Street 1:5907 W MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-6011
Practice Address - Country:US
Practice Address - Phone:903-759-6500
Practice Address - Fax:866-916-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty