Provider Demographics
NPI:1750905816
Name:IDEAL THERAPIES LLC
Entity type:Organization
Organization Name:IDEAL THERAPIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRIET
Authorized Official - Middle Name:DEANDRA
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:832-952-7566
Mailing Address - Street 1:13201 NORTHWEST FREEWAY FAIRBANKS/NORTHWEST CROSSING
Mailing Address - Street 2:SUITE 800 #1538
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-3399
Mailing Address - Country:US
Mailing Address - Phone:832-952-7566
Mailing Address - Fax:
Practice Address - Street 1:10225 WORTHAM BLVD APT 4204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3009
Practice Address - Country:US
Practice Address - Phone:601-566-3824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-RiskGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750905816Medicaid