Healthcare Provider Details

I. General information

NPI: 1942436100
Provider Name (Legal Business Name): PEDIATRIC PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 N 113TH AVE BUILDING A
YOUNGTOWN AZ
85363-1162
US

IV. Provider business mailing address

PO BOX 3457
CAREFREE AZ
85377-3457
US

V. Phone/Fax

Practice location:
  • Phone: 480-595-2184
  • Fax:
Mailing address:
  • Phone: 847-265-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PAULA CSEH
Title or Position: OWNER
Credential:
Phone: 480-595-2184