MEDICARE: PEDIATRICKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1053078584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICKS

Provider Business Mailing Address
First Line	:	23 FOREST CREEK DR
Second Line	:
City	:	HOCKESSIN
State	:	DE
Zip	:	19707-2017
Country	:	US
Telephone Number	:	302-540-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 FOREST CREEK DR
Second Line	:
City	:	HOCKESSIN
State	:	DE
Zip	:	19707-2017
Country	:	US
Telephone Number	:	302-540-7006
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST AND OWNER
Name	:	DR. JACLYN PETUYA
Credential	:	DPT
Telephone Number	:	302-540-7006

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	11/18/2021

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Directions to “PEDIATRICKS ” Practice Location

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