Provider Demographics
NPI:1093947848
Name:PEDIATRIC PHYSICAL THERAPY & SERVICES, INC.
Entity Type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY & SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LOE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, ECSE
Authorized Official - Phone:805-772-6014
Mailing Address - Street 1:2585 IRONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1755
Mailing Address - Country:US
Mailing Address - Phone:805-772-6014
Mailing Address - Fax:805-772-8246
Practice Address - Street 1:524 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1913
Practice Address - Country:US
Practice Address - Phone:805-772-6014
Practice Address - Fax:805-772-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty