Provider Demographics
NPI:1023480209
Name:ORION PEDIATRIC THERAPY
Entity type:Organization
Organization Name:ORION PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-983-2440
Mailing Address - Street 1:1606 E QUAIL ST
Mailing Address - Street 2:D
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7167
Mailing Address - Country:US
Mailing Address - Phone:956-983-2440
Mailing Address - Fax:832-582-3660
Practice Address - Street 1:1606 E QUAIL ST
Practice Address - Street 2:D
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7167
Practice Address - Country:US
Practice Address - Phone:956-983-2440
Practice Address - Fax:832-582-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101612235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101612OtherTEXAS BOARD SPEECH LICENSE