MEDICARE: PEDIATRIC THERAPY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1013194737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	10 EDGEWOOD DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4236
Country	:	US
Telephone Number	:	864-991-5460
Fax Number	:	864-335-1162

Provider Business Practice Location Address
First Line	:	10 EDGEWOOD DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4236
Country	:	US
Telephone Number	:	864-991-5460
Fax Number	:	864-335-1162

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TODD O'HARE
Credential	:	MS, PT
Telephone Number	:	864-991-5460

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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