Provider Demographics
NPI:1053078584
Name:PEDIATRICKS
Entity Type:Organization
Organization Name:PEDIATRICKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETUYA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:302-540-7006
Mailing Address - Street 1:23 FOREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-2017
Mailing Address - Country:US
Mailing Address - Phone:302-540-7006
Mailing Address - Fax:
Practice Address - Street 1:23 FOREST CREEK DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2017
Practice Address - Country:US
Practice Address - Phone:302-540-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty