MEDICARE: PEDIATRIC PHYSICAL THERAPY SERVICES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	252Y00000X	Early Intervention Provider Agency
3	235Z00000X	Speech-Language Pathologist
4	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200715730	OTHER	IN	FIRST STEPS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710040803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PHYSICAL THERAPY SERVICES, INC.

Provider Business Mailing Address
First Line	:	80 PROFESSIONAL CT
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5152
Country	:	US
Telephone Number	:	765-448-1758
Fax Number	:	765-448-3898

Provider Business Practice Location Address
First Line	:	80 PROFESSIONAL CT
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5152
Country	:	US
Telephone Number	:	765-448-1758
Fax Number	:	765-448-3898

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MRS. JAMIE SUE STORMONT-SMITH
Credential	:	PT PCS
Telephone Number	:	765-448-1758

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/10/2012

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