Healthcare Provider Details

I. General information

NPI: 1992599153
Provider Name (Legal Business Name): TH PEDIATRIC THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 W IRVING PARK RD
CHICAGO IL
60634-2103
US

IV. Provider business mailing address

7525 W IRVING PARK RD
CHICAGO IL
60634-2103
US

V. Phone/Fax

Practice location:
  • Phone: 630-640-6060
  • Fax:
Mailing address:
  • Phone: 630-640-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY MARIE HARRISON
Title or Position: PRESIDENT
Credential: DT
Phone: 630-640-6060