Provider Demographics
NPI:1871153635
Name:KATY PLAY GYM LLC
Entity type:Organization
Organization Name:KATY PLAY GYM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-827-3670
Mailing Address - Street 1:13776 N HWY 183 STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1875
Mailing Address - Country:US
Mailing Address - Phone:512-827-3670
Mailing Address - Fax:512-777-5042
Practice Address - Street 1:610 KATY FORT BEND RD STE 270
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7627
Practice Address - Country:US
Practice Address - Phone:281-786-4899
Practice Address - Fax:512-777-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty