Provider Demographics
NPI:1841509130
Name:OPENING GAITS PEDIATRIC CENTER, PLLC
Entity type:Organization
Organization Name:OPENING GAITS PEDIATRIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, OWNER, PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:254-939-3112
Mailing Address - Street 1:6514 W US HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6538
Mailing Address - Country:US
Mailing Address - Phone:254-939-3112
Mailing Address - Fax:254-933-9437
Practice Address - Street 1:6514 W US HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-6538
Practice Address - Country:US
Practice Address - Phone:254-939-3112
Practice Address - Fax:254-933-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10965012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty