EAST TEXAS PEDIATRIC REHABILITATION ASSOCIATES INC (NPI# 1871654244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871654244 |
| Entity Type | Organization |
| Organization Name | EAST TEXAS PEDIATRIC REHABILITATION ASSOCIATES INC |
| Other Organization Name | EAST TEXAS CHILDREN'S THERAPY SERVICES |
| Practice Address |
1001 W Southwest Loop 323 Tyler TX 75701-9416 |
| Practice Telephone | 9035091313 |
| Practice Fax Number | 9035091383 |
| Mailing Telephone | 9035091313 |
| Mailing Fax Number | 9035091383 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-06-27 |
| Authorized Official Name | KRISTI SMITH (PRESIDENT, OWNER) |
| Authorized Official Telephone | 9035091313 |
| Authorized Official Credential | PT, PCS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
651040000 | TX | Ambulatory Health Care Facilities |
| Y | 261QR0401X |
Clinic/Center Specialization: Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 158966501 | 05 |
| Other Name | Type Code |
|---|---|
| EAST TEXAS CHILDREN'S THERAPY SERVICES | Doing Business As Name - Organization |
| Street Address |
1001 W SOUTHWEST LOOP 323 |
| City | TYLER |
| State | TX |
| Zip Code | 75701-9416 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174148787 | Marcelina Perez | Behavior Technician | 1001 W Southwest Loop 323, Tyler, TX 75701-9416 | 2020-06-09 |
| 1477175685 | Jacy Lane Rogers | Behavior Technician | 1001 W Southwest Loop 323, Tyler, TX 75701-9416 | 2020-05-11 |
| 1821639816 | Cassie Jones | Behavior Technician | 1001 W Southwest Loop 323, Tyler, TX 75701-9416 | 2019-10-01 |
| 1568018612 | Nigel Thomas | Behavior Technician | 1001 W Southwest Loop 323, Tyler, TX 75701-9416 | 2019-08-14 |
| 1427560507 | Kristi Dubois | Speech-Language Pathologist | 1001 W Southwest Loop 323, Tyler, TX 75701-9416 | 2017-10-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 261QR0401X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447807615 | Rise Up Rehab, LLC | Clinic/Center | 1687 Old Hwy 90, Castroville, TX 78009 | 2019-08-22 |
| 1346897709 | Rise Up Rehab, LLC | Clinic/Center | 10410 Parrigin Rd, Helotes, TX 78023-4283 | 2019-08-21 |
| 1376016410 | Elite 360 Health and Wellness | Clinic/Center | 1409 S Lamar, Ste. 245, Dallas, TX 75215-6818 | 2019-01-10 |
| 1902333792 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 21004 Interstate 45 N, Spring, TX 77373-2917 | 2017-05-11 |
| 1023544418 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 5095 Preston Ave, Pasadena, TX 77505-2053 | 2017-05-04 |
| 1871029264 | Medcare Pediatric Rehab Center, Lp | Clinic/Center | 4818 E Sam Houston Pkwy N, Houston, TX 77015-3240 | 2017-05-04 |
| 1356793509 | Individual | Clinic/Center | 3500 Timberwood Cir Apt 2137, Arlington, TX 76015-3129 | 2016-07-11 |
| 1801242839 | Transitional Learning Center At Galveston | Clinic/Center | 4416 10th St, Lubbock, TX 79416-4800 | 2016-05-09 |
| 1225401805 | Milestones | Clinic/Center | 2704 S 26th St, Mcallen, TX 78503-7812 | 2015-11-04 |
| 1326421173 | Costa Therapy Institute, LLC | Clinic/Center | 1058 Palm Blvd, Brownsville, TX 78520-6168 | 2015-06-29 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EAST TEXAS PEDIATRIC REHABILITATION ASSOCIATES INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.