Provider Demographics
NPI:1982148151
Name:OUTREACH PEDIATRIC THERAPY & HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:OUTREACH PEDIATRIC THERAPY & HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FEARS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:210-525-8851
Mailing Address - Street 1:11310 SIR WINSTON ST
Mailing Address - Street 2:BLDG D
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2467
Mailing Address - Country:US
Mailing Address - Phone:210-525-8851
Mailing Address - Fax:210-525-8854
Practice Address - Street 1:11310 SIR WINSTON ST
Practice Address - Street 2:BLDG D
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2467
Practice Address - Country:US
Practice Address - Phone:210-525-8851
Practice Address - Fax:210-525-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health