Provider Demographics
NPI:1083407365
Name:FORT WORTH PEDIATRIC THERAPY PLLC
Entity type:Organization
Organization Name:FORT WORTH PEDIATRIC THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:817-253-9878
Mailing Address - Street 1:12800 PORTIFINO ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-6108
Mailing Address - Country:US
Mailing Address - Phone:817-253-9878
Mailing Address - Fax:
Practice Address - Street 1:12800 PORTIFINO ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76126-6108
Practice Address - Country:US
Practice Address - Phone:817-253-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty