Organization
BOOM PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN RIVERA-PEREZ (OWNER)
(469) 268-9010
Entity
Organization
Contact information
Practice address
1428 CARNATION ST, PROSPER, TX 75078-9779
(469) 268-9010
Mailing address
5900 BALCONES DR STE 100, AUSTIN, TX 78731-4298
(469) 268-9010
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
03/14/2023
Last updated
11/25/2023
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