Provider Demographics
NPI:1225376148
Name:FREEDOM PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:FREEDOM PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEVA
Authorized Official - Middle Name:S
Authorized Official - Last Name:REISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-367-4569
Mailing Address - Street 1:310 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3351
Mailing Address - Country:US
Mailing Address - Phone:732-367-4569
Mailing Address - Fax:732-367-3253
Practice Address - Street 1:310 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3351
Practice Address - Country:US
Practice Address - Phone:732-367-4569
Practice Address - Fax:732-367-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency