Provider Demographics
NPI:1447819123
Name:RELIANT PEDIATRIC THERAPY SERVICES, PC
Entity type:Organization
Organization Name:RELIANT PEDIATRIC THERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLENDU
Authorized Official - Middle Name:EKPE
Authorized Official - Last Name:OKORAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:713-366-2080
Mailing Address - Street 1:21630 MERCHANTS WAY
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2514
Mailing Address - Country:US
Mailing Address - Phone:832-230-1518
Mailing Address - Fax:
Practice Address - Street 1:312 E RENFRO ST STE 206
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3949
Practice Address - Country:US
Practice Address - Phone:832-230-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280099701Medicaid