Provider Demographics
NPI:1295076503
Name:LAREDO KIDS ADVANCED THERAPY INC.
Entity type:Organization
Organization Name:LAREDO KIDS ADVANCED THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAI
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-723-6600
Mailing Address - Street 1:4609 SAN DARIO AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5773
Mailing Address - Country:US
Mailing Address - Phone:956-723-6600
Mailing Address - Fax:956-723-6614
Practice Address - Street 1:4609 SAN DARIO AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5773
Practice Address - Country:US
Practice Address - Phone:956-723-6600
Practice Address - Fax:956-723-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676692Medicare Oscar/Certification