Provider Demographics
NPI:1356681076
Name:SMART PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:SMART PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:623-399-6159
Mailing Address - Street 1:13851 W LA MAR BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1389
Mailing Address - Country:US
Mailing Address - Phone:623-399-6159
Mailing Address - Fax:623-399-6416
Practice Address - Street 1:13851 W LA MAR BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1389
Practice Address - Country:US
Practice Address - Phone:623-399-6159
Practice Address - Fax:623-399-6416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1073861852OtherINDIVIDUAL NPI