Provider Demographics
NPI:1710240379
Name:WIGGLY KIDLETS
Entity Type:Organization
Organization Name:WIGGLY KIDLETS
Other - Org Name:NEW YORK PEDIATRIC REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TEACHER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OBARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-292-9106
Mailing Address - Street 1:7106 CHESTNUT OAK LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3063
Mailing Address - Country:US
Mailing Address - Phone:956-292-9106
Mailing Address - Fax:
Practice Address - Street 1:3145 CENTER POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8433
Practice Address - Country:US
Practice Address - Phone:956-292-9106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)