Provider Demographics
NPI:1407981053
Name:PEDIATRIC THERAPEUTICS, INC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPEUTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-497-0894
Mailing Address - Street 1:760 NEWTOWN YARDLEY RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1748
Mailing Address - Country:US
Mailing Address - Phone:215-497-0894
Mailing Address - Fax:215-497-0896
Practice Address - Street 1:760 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1748
Practice Address - Country:US
Practice Address - Phone:215-497-0894
Practice Address - Fax:215-497-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000058880009Medicaid