Provider Demographics
NPI:1902119092
Name:MUSTARD SEEDS THERAPY, INC
Entity Type:Organization
Organization Name:MUSTARD SEEDS THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-709-9031
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-0114
Mailing Address - Country:US
Mailing Address - Phone:817-709-9031
Mailing Address - Fax:
Practice Address - Street 1:5014 OAK BEND CIR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-3418
Practice Address - Country:US
Practice Address - Phone:817-709-9031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy