Provider Demographics
NPI:1164274726
Name:PEBBLES THERAPY LLC
Entity Type:Organization
Organization Name:PEBBLES THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNING
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:970-312-4102
Mailing Address - Street 1:5921 INDIAN WELLS CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528-9033
Mailing Address - Country:US
Mailing Address - Phone:970-312-4102
Mailing Address - Fax:
Practice Address - Street 1:5921 INDIAN WELLS CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-9033
Practice Address - Country:US
Practice Address - Phone:970-312-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency