Provider Demographics
NPI:1487160354
Name:PEDIATRIC THERAPY SERVICES OF TEXAS
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES OF TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-629-3293
Mailing Address - Street 1:201 FOCH STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107
Mailing Address - Country:US
Mailing Address - Phone:817-629-3293
Mailing Address - Fax:
Practice Address - Street 1:201 FOCH STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-629-3293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health