Provider Demographics
NPI:1366658569
Name:PEDIATRIC THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-487-7080
Mailing Address - Street 1:18555 N 79TH AVE
Mailing Address - Street 2:SUITE B101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8370
Mailing Address - Country:US
Mailing Address - Phone:623-487-7080
Mailing Address - Fax:623-487-4897
Practice Address - Street 1:18555 N 79TH AVE
Practice Address - Street 2:SUITE B101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8370
Practice Address - Country:US
Practice Address - Phone:623-487-7080
Practice Address - Fax:623-487-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty