Provider Demographics
NPI:1043939598
Name:TANDEM PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:TANDEM PEDIATRIC THERAPIES
Other - Org Name:THRIVE PEDIATRIC THERAPIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-494-2545
Mailing Address - Street 1:7115 SOUTHPOINT PKWY STE 5107
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2005
Mailing Address - Country:US
Mailing Address - Phone:419-494-2545
Mailing Address - Fax:
Practice Address - Street 1:7115 SOUTHPOINT PKWY STE 5107
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2005
Practice Address - Country:US
Practice Address - Phone:419-494-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty