1992012660 NPI number — SMALL HANDS BIG HEARTS PEDIATRIC THERAPY MANAGEMENT INC

NPI Number: 1992012660
Health Care Provider/Practitioner: SMALL HANDS BIG HEARTS PEDIATRIC THERAPY MANAGEMENT INC

NPI Number : 1992012660 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992012660",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SMALL HANDS BIG HEARTS PEDIATRIC THERAPY MANAGEMENT INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4775 NORTH FWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76106-2300",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "215-836-3131",
    "MailingAddressFaxNumber": "215-273-5975",
    "FirstLinePracticeLocationAddress": "4775 NORTH FWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WORTH",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76106-2300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "215-836-3131",
    "PracticeLocationAddressFaxNumber": "215-273-5975",
    "EnumerationDate": "09/01/2010",
    "LastUpdateDate": "12/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "YACOVELLI",
    "AuthorizedOfficialFirstName": "DERRICK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "BOARD MEMBER/CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "610-260-4601",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR0400X",
          "TaxonomyName": "Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251E00000X",
          "TaxonomyName": "Home Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}