=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407760986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BS PEDIATRIC THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2026
-----------------------------------------------------
Last Update Date | 09/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3935 W 20TH LN
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-5862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-384-3827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3935 W 20TH LN
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-5862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-384-3827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/CLINICAL MANAGER
-----------------------------------------------------
Name | BROOKE CARAGATA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 928-388-9897
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------