Provider Demographics
NPI:1649801283
Name:AMAZING REC THERAPY, LLC
Entity type:Organization
Organization Name:AMAZING REC THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:REQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CTRS
Authorized Official - Phone:281-819-2015
Mailing Address - Street 1:4830 WILSON RD STE 300-1027
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1971
Mailing Address - Country:US
Mailing Address - Phone:281-819-2015
Mailing Address - Fax:
Practice Address - Street 1:4830 WILSON RD STE 300-1027
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-1971
Practice Address - Country:US
Practice Address - Phone:619-415-9462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty