Provider Demographics
NPI:1265736029
Name:THERACARE P.C.
Entity type:Organization
Organization Name:THERACARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNI
Authorized Official - Middle Name:PROCTOR
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:361-550-0088
Mailing Address - Street 1:4504 LILAC LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2625
Mailing Address - Country:US
Mailing Address - Phone:361-550-4744
Mailing Address - Fax:361-582-4114
Practice Address - Street 1:4504 LILAC LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2625
Practice Address - Country:US
Practice Address - Phone:361-550-4744
Practice Address - Fax:361-582-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty