Healthcare Provider Details

I. General information

NPI: 1730389248
Provider Name (Legal Business Name): PEDIATRIC THERAPY WORKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 SR 580 STE 111
CLEARWATER FL
33761-3352
US

IV. Provider business mailing address

2753 SR 580 STE 111
CLEARWATER FL
33761-3352
US

V. Phone/Fax

Practice location:
  • Phone: 727-724-5437
  • Fax: 813-435-2125
Mailing address:
  • Phone: 727-724-5437
  • Fax: 813-435-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberOT 9659
License Number StateFL

VIII. Authorized Official

Name: MRS. AMY L PERRY
Title or Position: OWNER
Credential: OTR/L
Phone: 727-724-5437