Healthcare Provider Details

I. General information

NPI: 1255492864
Provider Name (Legal Business Name): PEDIATRIC THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 NE LOOP 286 STE 1800
PARIS TX
75460-5086
US

IV. Provider business mailing address

1620 SILVER LN
AUBREY TX
76227-1623
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 TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALICIA CLARK
Title or Position: PRESIDENT
Credential: OT
Phone: 866-832-1708