Healthcare Provider Details

I. General information

NPI: 1528506722
Provider Name (Legal Business Name): ASSOCIATES IN PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 PAOLI PIKE STE 5
FLOYDS KNOBS IN
47119-9787
US

IV. Provider business mailing address

3620 PAOLI PIKE STE 5
FLOYDS KNOBS IN
47119-9787
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1007
  • Fax: 502-805-1511
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-805-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMBER MINOR
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 502-633-1007