Healthcare Provider Details

I. General information

NPI: 1386988756
Provider Name (Legal Business Name): GROWING HEALTHY CHILDREN THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2012
Last Update Date: 11/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 WALNUT DR
RESCUE CA
95672-9316
US

IV. Provider business mailing address

3811 WALNUT DR
RESCUE CA
95672-9316
US

V. Phone/Fax

Practice location:
  • Phone: 510-589-2924
  • Fax: 888-538-0573
Mailing address:
  • Phone: 510-589-2924
  • Fax: 888-538-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number34567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number10164
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8849
License Number StateCA

VIII. Authorized Official

Name: JON CHU
Title or Position: OWNER/TREASURER
Credential: MSPT
Phone: 510-589-2924