Healthcare Provider Details

I. General information

NPI: 1598044281
Provider Name (Legal Business Name): PEDIATRICS PLUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 GRACE AVE
PANAMA CITY FL
32401-2521
US

IV. Provider business mailing address

927 GRACE AVE
PANAMA CITY FL
32401-2521
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-5371
  • Fax: 850-872-9558
Mailing address:
  • Phone: 850-769-5371
  • Fax: 850-872-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT5280
License Number StateFL

VIII. Authorized Official

Name: PAULA NELSON
Title or Position: PHYSICAL THERAPIST, OWNER
Credential:
Phone: 850-769-5371