Provider Demographics
NPI:1821729559
Name:MAR PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:MAR PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:VIOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-989-9750
Mailing Address - Street 1:702 RICHLAND HILLS DR.
Mailing Address - Street 2:P.O. BOX 760326
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245
Mailing Address - Country:US
Mailing Address - Phone:602-989-9750
Mailing Address - Fax:
Practice Address - Street 1:3903 WISEMAN BLVD STE 121B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4401
Practice Address - Country:US
Practice Address - Phone:726-242-5113
Practice Address - Fax:210-568-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty