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General NPI Number Information
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NPI Number | 1225414717
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Entity Type | Organization
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Legal Business Name | THROUGH THE ROOF PEDIATRIC THERAPY
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 1145 MILAM LN
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City | HERNANDO
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State | MS
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Zip | 38632-7719
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Country | US
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Telephone | 901-568-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 1895 THOUSAND OAKS DR
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City | HERNANDO
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State | MS
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Zip | 38632-8914
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Country | US
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Telephone | 901-568-2240
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, P.T.
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Name | DONNA B SULARIN
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Credential | P.T,
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Telephone | 901-568-2240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT2977
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License Number State | MS
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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 | S3688
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT0828
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License Number State | MS
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