Provider Demographics
NPI:1114098274
Name:EARLY CHOICE PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:EARLY CHOICE PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYSANE
Authorized Official - Last Name:PELLETIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT
Authorized Official - Phone:360-750-5850
Mailing Address - Street 1:208 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-1936
Mailing Address - Country:US
Mailing Address - Phone:360-750-5850
Mailing Address - Fax:360-750-7244
Practice Address - Street 1:106 E 15TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3401
Practice Address - Country:US
Practice Address - Phone:360-750-5850
Practice Address - Fax:360-750-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335184Medicaid