Provider Demographics
NPI:1013194737
Name:PEDIATRIC THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:O'HARE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:864-991-5460
Mailing Address - Street 1:10 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4236
Mailing Address - Country:US
Mailing Address - Phone:864-991-5460
Mailing Address - Fax:864-335-1162
Practice Address - Street 1:10 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4236
Practice Address - Country:US
Practice Address - Phone:864-991-5460
Practice Address - Fax:864-335-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty