Provider Demographics
NPI:1225250541
Name:PEDIATRIC THERAPY SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-477-8738
Mailing Address - Street 1:2604 WILLOWWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2267
Mailing Address - Country:US
Mailing Address - Phone:219-477-8738
Mailing Address - Fax:219-477-4572
Practice Address - Street 1:2604 WILLOWWOOD AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2267
Practice Address - Country:US
Practice Address - Phone:219-477-8738
Practice Address - Fax:219-477-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001032A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health