Provider Demographics
NPI:1669016036
Name:EARLY BIRD PEDIATRIC THERAPY CLINIC, INC
Entity type:Organization
Organization Name:EARLY BIRD PEDIATRIC THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-252-4509
Mailing Address - Street 1:2114 N ZARAGOZA RD STE C1
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-8129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD STE C1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8129
Practice Address - Country:US
Practice Address - Phone:915-271-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARLY BIRD PEDIATRIC THERAPY CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health