Provider Demographics
NPI:1871621888
Name:ROCKWALL CENTER OF SENSORY INTEGRATION
Entity type:Organization
Organization Name:ROCKWALL CENTER OF SENSORY INTEGRATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-771-5731
Mailing Address - Street 1:789 JUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4840
Mailing Address - Country:US
Mailing Address - Phone:972-771-5731
Mailing Address - Fax:972-771-5786
Practice Address - Street 1:789 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4840
Practice Address - Country:US
Practice Address - Phone:972-771-5731
Practice Address - Fax:972-771-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091163225100000X
TX1045052225100000X
TX1115517225100000X
TX100136225X00000X
TX110770225X00000X
TX112006225X00000X
TX19586235Z00000X
TX19998235Z00000X
TX18927235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094LVOtherBLUE CROSS BLUE SHIELD