Provider Demographics
NPI:1376514539
Name:PEDIATRIC THERAPY SERVICES INC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:507-388-5437
Mailing Address - Street 1:150 SAINT ANDREWS CT
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8659
Mailing Address - Country:US
Mailing Address - Phone:507-388-5437
Mailing Address - Fax:507-388-2108
Practice Address - Street 1:150 SAINT ANDREWS CT
Practice Address - Street 2:SUITE 310
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-8659
Practice Address - Country:US
Practice Address - Phone:507-388-5437
Practice Address - Fax:507-388-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123219OtherUCARE OF MN
MN78430OtherHEALTH PARTNERS, MN
MN211329500Medicaid
MN8B515PEOtherBCBS OF MN PT CLINIC #
MN8G323PEOtherBCBS OT CLINIC #
MN8G374PEOtherBCBS SPEECH #
MNPREFERRED ONEOtherPREFERRED ONE
MN246582Medicare ID - Type Unspecified