Healthcare Provider Details

I. General information

NPI: 1639303142
Provider Name (Legal Business Name): SPRINGFIELD PEDIATRIC THERAPY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 PARK PLAZA DR LOWER LEVEL
SPRINGFIELD TN
37172-3937
US

IV. Provider business mailing address

3902 N BRECKENRIDGE CT
SPRINGFIELD TN
37172-4350
US

V. Phone/Fax

Practice location:
  • Phone: 615-382-8863
  • Fax: 615-382-2662
Mailing address:
  • Phone: 615-478-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ERIN B COBB
Title or Position: OWNER
Credential: OTR
Phone: 615-478-1111