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General NPI Number Information
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NPI Number | 1730963877
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Entity Type | Organization
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Legal Business Name | 123 GROW PEDIATRIC THERAPY INC.
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 932 CADMAN DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1528
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Country | US
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Telephone | 845-558-2241
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Fax |
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Provider Business Mailing Address
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Address Line | 932 CADMAN DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-1528
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Country | US
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Telephone | 845-558-2241
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMANDA VAUGHAN
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Credential |
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Telephone | 845-558-2241
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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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