Provider Demographics
NPI:1043605892
Name:PEDIATRIC THERAPY SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:DOTSON
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:540-577-0213
Mailing Address - Street 1:1032 MACGILL ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-4022
Mailing Address - Country:US
Mailing Address - Phone:540-577-0213
Mailing Address - Fax:
Practice Address - Street 1:1032 MACGILL ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-4022
Practice Address - Country:US
Practice Address - Phone:540-577-0213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003883252Y00000X
VA2306001318252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency