Provider Demographics
NPI:1093224784
Name:PEDIATRIC ENHANCEMENT OF DEVELOPMENTAL SKILLS LLC
Entity Type:Organization
Organization Name:PEDIATRIC ENHANCEMENT OF DEVELOPMENTAL SKILLS LLC
Other - Org Name:PEDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE-ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:303-974-0246
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-0121
Mailing Address - Country:US
Mailing Address - Phone:303-974-0246
Mailing Address - Fax:
Practice Address - Street 1:15006 OVERLAND TRL
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80603
Practice Address - Country:US
Practice Address - Phone:303-974-0246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty