Provider Demographics
NPI:1801342324
Name:ROUND ROCK CHILDRENS THERAPY CENTER
Entity type:Organization
Organization Name:ROUND ROCK CHILDRENS THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALTHAZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-341-9991
Mailing Address - Street 1:901 ROUND ROCK AVE
Mailing Address - Street 2:BUILDING E
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4514
Mailing Address - Country:US
Mailing Address - Phone:512-341-9991
Mailing Address - Fax:512-341-0019
Practice Address - Street 1:901 ROUND ROCK AVE
Practice Address - Street 2:BUILDING E
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4514
Practice Address - Country:US
Practice Address - Phone:512-341-9991
Practice Address - Fax:512-341-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX382372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty