Provider Demographics
NPI:1912272238
Name:KIDDO'S REHAB 2, LLC
Entity Type:Organization
Organization Name:KIDDO'S REHAB 2, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROEL
Authorized Official - Suffix:
Authorized Official - Credentials:SLPA
Authorized Official - Phone:956-380-4300
Mailing Address - Street 1:524 S CLOSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4660
Mailing Address - Country:US
Mailing Address - Phone:956-380-4300
Mailing Address - Fax:956-380-4361
Practice Address - Street 1:524 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4660
Practice Address - Country:US
Practice Address - Phone:956-380-4300
Practice Address - Fax:956-380-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX562550000225X00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty