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General NPI Number Information
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NPI Number | 1366609166
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Entity Type | Organization
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Legal Business Name | CHILDREN'S THERAPY CONNECTION, INC.
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 7209 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2021
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Country | US
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Telephone | 317-288-7606
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Fax | 317-288-7607
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Provider Business Mailing Address
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Address Line | 7209 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2021
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Country | US
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Telephone | 317-288-7606
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON BERTY
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Credential | PT, CSCS
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Telephone | 317-288-7606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 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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