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General NPI Number Information
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NPI Number | 1861935033
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PT LLC.
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 1705 LEIGHTON AVE
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City | ANNISTON
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State | AL
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Zip | 36207-3832
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Country | US
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Telephone | 256-235-2524
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Fax | 256-236-2573
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Provider Business Mailing Address
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Address Line | 1106 HERITAGE LN NE
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City | JACKSONVILLE
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State | AL
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Zip | 36265-1255
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Country | US
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Telephone | 256-235-2524
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Fax | 256-236-2573
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TANJA ELLIOTT
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Credential |
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Telephone | 256-235-2524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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