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General NPI Number Information
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NPI Number | 1134581788
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY ASSOCIATES OF NE, PA INC
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 117 SYMPHONY TER
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City | SHOHOLA
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State | PA
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Zip | 18458-3601
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Country | US
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Telephone | 570-228-6838
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Fax |
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Provider Business Mailing Address
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Address Line | 117 SYMPHONY TER
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City | SHOHOLA
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State | PA
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Zip | 18458-3601
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Country | US
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Telephone | 570-228-6838
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR, SPEECH PATHOLOGIST
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Name | MRS. JULIE MCHALE DABNEY
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Credential | MS, CCC-SLP
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Telephone | 570-228-6838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL007750
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License Number State | PA
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