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NPI Code Detail

MEDICARE: NORTH VALLEY PEDIATRIC THERAPY, LLC

MEDICARE: NORTH VALLEY PEDIATRIC THERAPY, 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
12080P0006XDevelopmental - Behavioral Pediatrics Physician
2103K00000XBehavior Analyst
3103T00000XPsychologist
4261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1366899171
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH VALLEY PEDIATRIC THERAPY, LLC
Provider Business Mailing Address
First Line : 1831 W ROSE GARDEN LN STE 4
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-2725
Country : US
Telephone Number : 602-808-9912
Fax Number :
Provider Business Practice Location Address
First Line : 1831 W ROSE GARDEN LN STE 4
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-2725
Country : US
Telephone Number : 602-808-9912
Fax Number : 602-875-0385
Authorized Official
Title or Position : CEO
Name : JAXSON MYERS
Credential :
Telephone Number : 602-609-3777
Provider Enumeration Date : 05/22/2016
Last Update Date : 06/05/2026

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Directions to “NORTH VALLEY PEDIATRIC THERAPY, LLC ” Practice Location

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