Healthcare Provider Details

I. General information

NPI: 1992381628
Provider Name (Legal Business Name): PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 TEASLEY LN
DENTON TX
76205-7946
US

IV. Provider business mailing address

1302 TEASLEY LN
DENTON TX
76205-7946
US

V. Phone/Fax

Practice location:
  • Phone: 866-832-1708
  • Fax: 888-789-4391
Mailing address:
  • Phone: 866-832-1708
  • Fax: 888-789-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES CLARK
Title or Position: VP OF OPERATIONS
Credential:
Phone: 866-832-1708