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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