NPIMap

Organization Active NPI

Fantastic Kids Therapy PLLC

  • Pediatric Occupational Therapist
  • Laredo, TX
National Provider Identifier
1104141019
Registry record updated Apr 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
110165 Issued in TX
Legal business name
FANTASTIC KIDS THERAPY PLLC
Practice address
1519 E Bustamante St Ste G
Laredo, TX 78041-5305
Phone
(956) 208-8707
NPI assigned
Apr 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Aide Garza, LOTR
Title
Managing Member
Phone
(956) 488-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225XP0200X 110165 TX Primary

Addresses

Primary practice location

1519 E Bustamante St Ste G
Laredo, TX 78041-5305

Mailing address

500 Godorniz
Rio Grande City, TX 78582-6656
Phone (956) 844-1031

Other names 1

  • Fantastic Kids Therapy PLLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Fantastic Kids Therapy PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1519 E Bustamante St
Ste G
Laredo, TX 78041
Phone (956) 208-8707

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270166400000",
    "number": "1104141019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 GODORNIZ",
            "city": "RIO GRANDE CITY",
            "state": "TX",
            "postal_code": "785826656",
            "telephone_number": "956-844-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 E BUSTAMANTE ST STE G",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780415305",
            "telephone_number": "956-208-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANTASTIC KIDS THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-02",
        "last_updated": "2010-04-02",
        "status": "A",
        "authorized_official_last_name": "GARZA",
        "authorized_official_first_name": "AIDE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "956-488-8100",
        "authorized_official_credential": "LOTR"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "110165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fantastic Kids Therapy PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Laredo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.