Healthcare Provider Details

I. General information

NPI: 1255390928
Provider Name (Legal Business Name): PEDIATRIC THERAPY INTERVENTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 MCDADE RD
HEPHZIBAH GA
30815-4721
US

IV. Provider business mailing address

2065 MCDADE RD
HEPHZIBAH GA
30815-4721
US

V. Phone/Fax

Practice location:
  • Phone: 706-951-7013
  • Fax: 706-592-6872
Mailing address:
  • Phone: 706-951-7013
  • Fax: 706-592-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAUL DAVIS
Title or Position: CEO
Credential:
Phone: 706-951-7013