Provider Demographics
NPI:1750513883
Name:G MAES KIDS SMALL STEPS PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:G MAES KIDS SMALL STEPS PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-723-7178
Mailing Address - Street 1:1510 PECAN TRACE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6224
Mailing Address - Country:US
Mailing Address - Phone:903-723-7178
Mailing Address - Fax:903-723-8252
Practice Address - Street 1:1510 PECAN TRACE CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6224
Practice Address - Country:US
Practice Address - Phone:903-723-7178
Practice Address - Fax:903-723-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11488052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty