East Texas Pediatric Therapy

NPI #1740422575 in Edgewood, Texas

Provider Information

NPI Number: 1740422575
Entity Type: Organization
Organization Name: East Texas Pediatric Therapy
Primary Specialty: Contractor
Enumeration Date: Mar 25, 2009
Last Updated: Mar 25, 2009

Practice Location

Address: 1738 VZCR 3103
City: Edgewood
State: Texas
ZIP Code: 75117-5020
Phone: (214) 336-2248

Authorized Official

Name: MRS. DAWN M GOBER, PTA
Title: OWNER/PTA
Phone: (214) 336-2248

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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