Provider Demographics
NPI:1134668957
Name:PEDIATRIC THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALITA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:812-306-5989
Mailing Address - Street 1:4605 BOARDWALK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-8938
Mailing Address - Country:US
Mailing Address - Phone:812-306-5989
Mailing Address - Fax:
Practice Address - Street 1:4605 BOARDWALK DR
Practice Address - Street 2:SUITE C
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-8938
Practice Address - Country:US
Practice Address - Phone:812-306-5989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171683252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency