Healthcare Provider Details

I. General information

NPI: 1386393387
Provider Name (Legal Business Name): PEDIATRIC PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 W MLK BLVD
TAMPA FL
33607-6223
US

IV. Provider business mailing address

601 5TH ST S DEPT 6941
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-5140
  • Fax: 813-350-0132
Mailing address:
  • Phone: 727-767-4429
  • Fax: 727-767-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTY ALICIA SCHULHOF
Title or Position: PRESIDENT
Credential:
Phone: 727-898-7451