Provider Demographics
NPI:1851547418
Name:DYNAMIC CHILDREN THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:DYNAMIC CHILDREN THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS, ASST/SLP
Authorized Official - Phone:956-581-6919
Mailing Address - Street 1:1110 S INSPIRATION RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6983
Mailing Address - Country:US
Mailing Address - Phone:956-581-6919
Mailing Address - Fax:
Practice Address - Street 1:1110 S INSPIRATION RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6983
Practice Address - Country:US
Practice Address - Phone:956-581-6919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341922355S0801X
TX349522355S0801X
TX14464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty