Healthcare Provider Details

I. General information

NPI: 1871769349
Provider Name (Legal Business Name): PEDIATRIC THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 RIDGEWOOD AVE
BRANDON FL
33510
US

IV. Provider business mailing address

206 RIDGEWOOD AVE
BRANDON FL
33510-4617
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-1060
  • Fax: 813-662-0530
Mailing address:
  • Phone: 813-662-1060
  • Fax: 813-662-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT5990
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT1478
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7398
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPT2549
License Number StateFL

VIII. Authorized Official

Name: GRAHAM KILBURN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 813-662-1060