Provider Demographics
NPI:1407976327
Name:PEDIATRIC THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GORIN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC, SLP
Authorized Official - Phone:502-797-1371
Mailing Address - Street 1:2001 LONG KNIFE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1176
Mailing Address - Country:US
Mailing Address - Phone:502-797-1371
Mailing Address - Fax:502-721-6132
Practice Address - Street 1:2001 LONG KNIFE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1176
Practice Address - Country:US
Practice Address - Phone:502-797-1371
Practice Address - Fax:502-721-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001261A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty