Healthcare Provider Details

I. General information

NPI: 1881355147
Provider Name (Legal Business Name): ALLY PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 S HIGLEY RD
GILBERT AZ
85296-4793
US

IV. Provider business mailing address

2301 E YEAGER DR STE 14
CHANDLER AZ
85286-1578
US

V. Phone/Fax

Practice location:
  • Phone: 480-297-0894
  • Fax: 844-475-2307
Mailing address:
  • Phone: 602-606-2237
  • Fax: 844-475-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SEFFEL
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 714-616-0494