Provider Demographics
NPI:1710588082
Name:THERASPACE LLP
Entity Type:Organization
Organization Name:THERASPACE LLP
Other - Org Name:THERASPACE LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:409-670-6566
Mailing Address - Street 1:269 COUNTY ROAD 4185
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-8620
Mailing Address - Country:US
Mailing Address - Phone:409-670-6566
Mailing Address - Fax:
Practice Address - Street 1:4700 HIGHWAY 365 STE J
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7719
Practice Address - Country:US
Practice Address - Phone:409-670-6566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty