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General NPI Number Information
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NPI Number | 1194349647
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Entity Type | Organization
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Legal Business Name | THERAPY TIME PEDIATRICS ST LLC
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 16 S A AVE UNIT 684
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City | BIXBY
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State | OK
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Zip | 74008-4570
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Country | US
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Telephone | 918-798-2116
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Fax | 918-513-6777
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Provider Business Mailing Address
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Address Line | 16 S A AVE UNIT 684
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City | BIXBY
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State | OK
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Zip | 74008-4570
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Country | US
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Telephone | 918-798-2116
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Fax | 918-513-6777
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Authorized Official
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Title or Position | OWNER
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Name | CATHY ROSS
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Credential | MC CCC-SLP
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Telephone | 918-798-2116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical 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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