Provider Demographics
NPI:1689123598
Name:TWINKLE TYKES THERAPY
Entity Type:Organization
Organization Name:TWINKLE TYKES THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-682-0554
Mailing Address - Street 1:7703 MISTY FERN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4450
Mailing Address - Country:US
Mailing Address - Phone:281-682-0554
Mailing Address - Fax:346-978-5755
Practice Address - Street 1:7703 MISTY FERN CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-4450
Practice Address - Country:US
Practice Address - Phone:281-682-0554
Practice Address - Fax:346-978-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11151522251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211083501Medicaid