Provider Demographics
NPI:1902201387
Name:LITTLE LAND PEDIATRIC THERAPY & PLAY GYM
Entity Type:Organization
Organization Name:LITTLE LAND PEDIATRIC THERAPY & PLAY GYM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-773-9182
Mailing Address - Street 1:PO BOX 171273
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0043
Mailing Address - Country:US
Mailing Address - Phone:512-827-3601
Mailing Address - Fax:512-777-5042
Practice Address - Street 1:13776 N HIGHWAY 183
Practice Address - Street 2:SUITE 107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1872
Practice Address - Country:US
Practice Address - Phone:512-827-3601
Practice Address - Fax:512-777-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty