Provider Demographics
NPI:1891885927
Name:THE THERAPY VILLAGE
Entity Type:Organization
Organization Name:THE THERAPY VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:NGO
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:281-477-9500
Mailing Address - Street 1:14815 CYPRESS N. HOUSTON ROAD, SUITE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6182
Mailing Address - Country:US
Mailing Address - Phone:281-477-9500
Mailing Address - Fax:281-477-9563
Practice Address - Street 1:14815 CYPRESS N. HOUSTON ROAD, SUITE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6182
Practice Address - Country:US
Practice Address - Phone:281-477-9500
Practice Address - Fax:281-477-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1787733501Medicaid