# LAKE CITIES ELITE PERFORMANCE THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elite Performance Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437441854
- **Authorized official:** ANA HERNANDO OTR, MOT (OWNER/THERAPIST IN CHARGE)
- **Authorized official phone:** (855) 204-4540

## Contact information

- **Practice address:** 109 RED BLUFF DR, HICKORY CREEK, TX 75065-3618
- **Practice address phone:** (855) 204-4540
- **Practice address fax:** (940) 293-8555
- **Mailing address:** 109 RED BLUFF DR, HICKORY CREEK, TX 75065-3618
- **Mailing address phone:** (855) 204-4540
- **Mailing address fax:** (940) 293-8555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 563080000 | TX | Yes |

## Other

- **Enumeration date:** 05/03/2011
- **Last updated:** 05/03/2011