Provider Demographics
NPI:1104867670
Name:JANET S MOULTON INC
Entity Type:Organization
Organization Name:JANET S MOULTON INC
Other - Org Name:PEDIATRIC THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:904-249-8893
Mailing Address - Street 1:340 16TH AVE N
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4819
Mailing Address - Country:US
Mailing Address - Phone:904-249-8893
Mailing Address - Fax:904-372-0496
Practice Address - Street 1:340 16TH AVE N
Practice Address - Street 2:STE B
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4819
Practice Address - Country:US
Practice Address - Phone:904-249-8893
Practice Address - Fax:904-372-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
FLSA4951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884273600Medicaid
FLS1828OtherBC/BS