Provider Demographics
NPI:1184745291
Name:CENTER FOR PEDIATRIC THERAPY
Entity type:Organization
Organization Name:CENTER FOR PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:281-292-4800
Mailing Address - Street 1:2721 N LOGRUN CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4010
Mailing Address - Country:US
Mailing Address - Phone:281-292-4800
Mailing Address - Fax:281-292-9588
Practice Address - Street 1:19221 INTERSTATE 45 S
Practice Address - Street 2:SUITE 360
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8756
Practice Address - Country:US
Practice Address - Phone:281-292-4800
Practice Address - Fax:281-292-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX2251P0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty