Healthcare Provider Details

I. General information

NPI: 1528726619
Provider Name (Legal Business Name): PEDIATRIC THERAPY SOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S CONGRESS AVE STE G
BOYNTON BEACH FL
33426-8488
US

IV. Provider business mailing address

3600 S CONGRESS AVE STE G
BOYNTON BEACH FL
33426-8488
US

V. Phone/Fax

Practice location:
  • Phone: 561-926-5609
  • Fax: 561-231-6498
Mailing address:
  • Phone: 561-926-5609
  • Fax: 561-231-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALISON BERG
Title or Position: OWNER/SPEECH LANGUAGE PATHOLOGIST
Credential: MS CCC SLP
Phone: 732-232-1126