Provider Demographics
NPI:1861822546
Name:EXTRA CREDIT LLC
Entity Type:Organization
Organization Name:EXTRA CREDIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:512-689-0236
Mailing Address - Street 1:8820 BUSINESS PARK DR
Mailing Address - Street 2:#300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7456
Mailing Address - Country:US
Mailing Address - Phone:512-689-0236
Mailing Address - Fax:512-201-2989
Practice Address - Street 1:8820 BUSINESS PARK DR
Practice Address - Street 2:#300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7456
Practice Address - Country:US
Practice Address - Phone:512-689-0236
Practice Address - Fax:512-201-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110741261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation