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NPI Code Detail

MEDICARE: ALLY PEDIATRIC THERAPY LLC

MEDICARE: ALLY PEDIATRIC THERAPY LLC
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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3235Z00000XSpeech-Language Pathologist
4103K00000XBehavior Analyst

General Provider Information

NPI Number : 1356002760
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLY PEDIATRIC THERAPY LLC
Provider Business Mailing Address
First Line : 2301 E YEAGER DR STE 14
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-1578
Country : US
Telephone Number : 602-606-2237
Fax Number : 844-475-2307
Provider Business Practice Location Address
First Line : 15220 S 50TH ST STE 105
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-9132
Country : US
Telephone Number : 480-795-7165
Fax Number : 844-475-2307
Authorized Official
Title or Position : CEO
Name : ANTHONY MACLEOD
Credential :
Telephone Number : 602-606-2237
Provider Enumeration Date : 01/07/2022
Last Update Date : 01/07/2022

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Directions to “ALLY PEDIATRIC THERAPY LLC ” Practice Location

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