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General NPI Number Information
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NPI Number | 1710895800
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Entity Type | Organization
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Legal Business Name | GREEN JELLYBEAN PEDIATRIC THERAPY, INC.
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 140 S CHAPARRAL CT STE 160
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City | ANAHEIM
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State | CA
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Zip | 92808-2283
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Country | US
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Telephone | 714-794-5889
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Fax |
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Provider Business Mailing Address
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Address Line | 140 S CHAPARRAL CT STE 160
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City | ANAHEIM
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State | CA
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Zip | 92808-2283
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Country | US
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Telephone | 714-794-5889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY FREVERT
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Credential | PT
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Telephone | 714-794-5889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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