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General NPI Number Information
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NPI Number | 1073913893
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPIES OF NORTHWEST FLORIDA, LLC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 7840 LILAC LN APT 508
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City | PENSACOLA
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State | FL
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Zip | 32514-7668
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Country | US
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Telephone | 850-260-9016
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Fax | 850-912-8561
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Provider Business Mailing Address
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Address Line | 7840 LILAC LN APT 508
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City | PENSACOLA
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State | FL
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Zip | 32514-7668
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Country | US
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Telephone | 850-260-9016
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Fax | 850-912-8561
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Authorized Official
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Title or Position | OWNER
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Name | MR. TYLER RUSSELL STEVERSON
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Credential |
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Telephone | 850-260-9016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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