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Organization
TADPOLES PEDIATRIC THERAPY
Active
Organization
TADPOLES PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULISSA IRACHETA (ADMINISTRATOR)
(214) 302-9725
Entity
Organization
Contact information
Practice address
8101 BOAT CLUB RD, SUITE 160, FORT WORTH, TX 76179-3630
(214) 302-9725
(214) 935-2457
Mailing address
3901 PUEBLO TRL, LAKE WORTH, TX 76135-2872
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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