Healthcare Provider Details

I. General information

NPI: 1649987785
Provider Name (Legal Business Name): TINY TOTS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3274 S HART STREET RD
VINCENNES IN
47591-8982
US

IV. Provider business mailing address

3274 S HART STREET RD
VINCENNES IN
47591-8982
US

V. Phone/Fax

Practice location:
  • Phone: 765-760-4701
  • Fax:
Mailing address:
  • Phone: 765-760-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. FRANK FREDEREIC HAYS
Title or Position: VICE PRESIDENT
Credential:
Phone: 765-760-4701