Healthcare Provider Details

I. General information

NPI: 1740191089
Provider Name (Legal Business Name): ACT PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARYLAND CIR APT 101
WHITEHALL PA
18052-6336
US

IV. Provider business mailing address

3 MARYLAND CIR APT 101
WHITEHALL PA
18052-6336
US

V. Phone/Fax

Practice location:
  • Phone: 484-274-4703
  • Fax:
Mailing address:
  • Phone: 484-274-4703
  • Fax:

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: MRS. MICHELLE PAULINO
Title or Position: PRESIDENT
Credential: M.S., CCC-SLP
Phone: 484-274-4703