Healthcare Provider Details

I. General information

NPI: 1083477558
Provider Name (Legal Business Name): PEDIATRIC THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 FAYETTE ST
CONSHOHOCKEN PA
19428-1702
US

IV. Provider business mailing address

525 FAYETTE ST
CONSHOHOCKEN PA
19428-1702
US

V. Phone/Fax

Practice location:
  • Phone: 610-941-7020
  • Fax:
Mailing address:
  • Phone: 610-941-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL L HAIBACH
Title or Position: PRACTICE LEADER
Credential: PT
Phone: 412-585-0313