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
1	235Z00000X	Speech-Language Pathologist	SLP9461	AZ
2	235Z00000X	Speech-Language Pathologist	9461	AZ
3	103K00000X	Behavior Analyst	BA-114	AZ

General Provider Information

NPI Number	:	1427422179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLY PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	10595 N TATUM BLVD STE E146
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-1072
Country	:	US
Telephone Number	:	602-606-2237
Fax Number	:	844-475-2307

Provider Business Practice Location Address
First Line	:	10595 N TATUM BLVD STE E146
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253
Country	:	US
Telephone Number	:	602-606-2237
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	ELIZABETH SEFFEL
Credential	:
Telephone Number	:	714-616-0494

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	04/23/2026

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Directions to “ALLY PEDIATRIC THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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