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Organization
LAKE CITIES ELITE PERFORMANCE THERAPY
Active
Organization
LAKE CITIES ELITE PERFORMANCE THERAPY
Active
Other names
Elite Performance Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ANA HERNANDO OTR, MOT (OWNER/THERAPIST IN CHARGE)
(855) 204-4540
Entity
Organization
Contact information
Practice address
109 RED BLUFF DR, HICKORY CREEK, TX 75065-3618
(855) 204-4540
(940) 293-8555
Mailing address
109 RED BLUFF DR, HICKORY CREEK, TX 75065-3618
(855) 204-4540
(940) 293-8555
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
563080000
TX
Other
Enumeration date
05/03/2011
Last updated
05/03/2011
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