Healthcare Provider Details

I. General information

NPI: 1124933031
Provider Name (Legal Business Name): PANHANDLE PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 7TH ST STE 2
CHIPLEY FL
32428-1940
US

IV. Provider business mailing address

2413 HIGHWAY 77
CHIPLEY FL
32428-5769
US

V. Phone/Fax

Practice location:
  • Phone: 850-260-8903
  • Fax:
Mailing address:
  • Phone: 850-260-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MADISON PEMBERTON
Title or Position: OWNER/PHYSICAL THERAPIST
Credential:
Phone: 850-260-8903