Provider Demographics
NPI:1669119376
Name:TAPESTRY PEDIATRIC THERAPY PLLC
Entity type:Organization
Organization Name:TAPESTRY PEDIATRIC THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEGIOANNI
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:832-244-1964
Mailing Address - Street 1:13542 COUNTRY CIR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3058
Mailing Address - Country:US
Mailing Address - Phone:832-244-1964
Mailing Address - Fax:
Practice Address - Street 1:13542 COUNTRY CIR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3058
Practice Address - Country:US
Practice Address - Phone:832-244-1964
Practice Address - Fax:855-940-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114046OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION