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General NPI Number Information
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NPI Number | 1427422179
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Entity Type | Organization
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Legal Business Name | ALLY PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 10595 N TATUM BLVD STE E146
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253
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Country | US
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Telephone | 602-606-2237
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Fax |
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Provider Business Mailing Address
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Address Line | 10595 N TATUM BLVD STE E146
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-1072
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Country | US
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Telephone | 602-606-2237
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Fax | 844-475-2307
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ANTHONY MACLEOD
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Credential |
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Telephone | 602-606-2237
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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 | 9461
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License Number State | AZ
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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 | SLP9461
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-114
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License Number State | AZ
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