Provider Demographics
NPI:1871920173
Name:KIDZ ROCK THERAPY, PLLC
Entity type:Organization
Organization Name:KIDZ ROCK THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:956-750-3161
Mailing Address - Street 1:102 1ST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-4282
Mailing Address - Country:US
Mailing Address - Phone:956-750-3161
Mailing Address - Fax:956-750-3238
Practice Address - Street 1:102 1ST AVE STE C
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-4282
Practice Address - Country:US
Practice Address - Phone:956-750-3161
Practice Address - Fax:956-750-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286233603Medicaid