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NPI Code Detail

MEDICARE: ODYSSEY PEDIATRIC THERAPY, LLC

MEDICARE: ODYSSEY 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
1101Y00000XCounselor
2225100000XPhysical Therapist
3225X00000XOccupational Therapist
4235Z00000XSpeech-Language Pathologist
5103K00000XBehavior Analyst

General Provider Information

NPI Number : 1750994224
Entity Type Code : Organization
Provider Name (Legal Business Name) : ODYSSEY PEDIATRIC THERAPY, LLC
Provider Business Mailing Address
First Line : 13931 SIERRA STAR CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-2976
Country : US
Telephone Number : 719-283-1406
Fax Number : 719-249-5834
Provider Business Practice Location Address
First Line : 13931 SIERRA STAR CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-2976
Country : US
Telephone Number : 719-283-1406
Fax Number : 719-249-5834
Authorized Official
Title or Position : PRESIDENT
Name : ANTHONY ANDRIANO
Credential :
Telephone Number : 719-467-7018
Provider Enumeration Date : 08/25/2020
Last Update Date : 06/04/2025

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Directions to “ODYSSEY PEDIATRIC THERAPY, LLC ” Practice Location

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