Provider Demographics
NPI:1225414717
Name:THROUGH THE ROOF PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:THROUGH THE ROOF PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, P.T.
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SULARIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,
Authorized Official - Phone:901-568-2240
Mailing Address - Street 1:1895 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8914
Mailing Address - Country:US
Mailing Address - Phone:901-568-2240
Mailing Address - Fax:
Practice Address - Street 1:1145 MILAM LN
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-7719
Practice Address - Country:US
Practice Address - Phone:901-568-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT08282251P0200X
MSOT2977225XP0200X
MSS3688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty