Provider Demographics
NPI:1902907868
Name:CHILDRENS OCCUPATIONAL, PHYSICAL, SPEECH THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:CHILDRENS OCCUPATIONAL, PHYSICAL, SPEECH THERAPY SERVICES, PLLC
Other - Org Name:CHILDRENS THERAPY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-331-1999
Mailing Address - Street 1:9907 GRAND OAK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3819
Mailing Address - Country:US
Mailing Address - Phone:512-331-1999
Mailing Address - Fax:512-331-9199
Practice Address - Street 1:6102 SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7818
Practice Address - Country:US
Practice Address - Phone:512-331-1999
Practice Address - Fax:512-331-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty