Provider Demographics
NPI:1407834021
Name:PEDIATRIC THERAPY SERVICES INC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER, OTR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:863-802-3800
Mailing Address - Street 1:1215 E ORANGE STREET
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5762
Mailing Address - Country:US
Mailing Address - Phone:863-802-3800
Mailing Address - Fax:863-802-0480
Practice Address - Street 1:1215 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:863-802-3800
Practice Address - Fax:863-802-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 261Q00000X
FLPT00025492251P0200X
FLOT12452225XP0200X
FLSA5826235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, 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
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024298400Medicaid
FL8810363001OtherCIGNA HEALTHCARE
FL880357904Medicaid
FLP10705914OtherSIMPLY HEALTHCARE MEDICAID HMO
FL664175OtherAETNA HEALTHCARE
FLY905LOtherBCBS OF FL GROUP ID
FL13424302OtherCITRUS HEALTHCARE GRP ID
FL6406221OtherUNITED HEALTHCARE
FL1407834021OtherCIGNA BAYCARE
FL880357900Medicaid
FLY906FOtherBCBS FL GROUP ID
FL6406221OtherUNITED HEALTHCARE MEDICAID HMO
FL13424302OtherCITRUS HEALTHCARE GRP ID
FLP10705914OtherSIMPLY HEALTHCARE MEDICAID HMO
FL=========Other1ST SERVICES ADM
FL6406221OtherUNITED HEALTHCARE MEDICAID HMO
FL8810363001OtherCIGNA HEALTHCARE
FL=========OtherCHILDREN'S MEDICAL SERVICES
FL=========OtherHUMANA
FL=========OtherTRICARE
FLY906FOtherBCBS FL GROUP ID