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General NPI Number Information
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NPI Number | 1134152861
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 7591 TYLERS PLACE BLVD
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City | WEST CHESTER
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State | OH
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Zip | 45069
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Country | US
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Telephone | 513-755-6600
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Fax | 513-755-3762
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Provider Business Mailing Address
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Address Line | 1311 MAMARONECK AVE STE 140
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5224
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Country | US
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Telephone | 914-294-4050
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL L RUCKER
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Credential |
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Telephone | 732-678-6119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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