Organization
FANTASTIC KIDS THERAPY PLLC
Active
Other names
Fantastic Kids Therapy PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
AIDE GARZA LOTR (MANAGING MEMBER)
(956) 488-8100
Entity
Organization
Contact information
Practice address
1519 E BUSTAMANTE ST STE G, LAREDO, TX 78041-5305
(956) 208-8707
Mailing address
500 GODORNIZ, RIO GRANDE CITY, TX 78582-6656
(956) 844-1031
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
110165
TX
Other
Enumeration date
04/02/2010
Last updated
04/02/2010
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