Provider Demographics
NPI:1417005984
Name:PEDIATRIC PHYSICAL & OCCUPATIONAL THERAPY SERVICES, P.L.L.C.
Entity Type:Organization
Organization Name:PEDIATRIC PHYSICAL & OCCUPATIONAL THERAPY SERVICES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-739-0583
Mailing Address - Street 1:133 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2175
Mailing Address - Country:US
Mailing Address - Phone:607-739-0583
Mailing Address - Fax:607-739-1364
Practice Address - Street 1:133 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2175
Practice Address - Country:US
Practice Address - Phone:607-739-0583
Practice Address - Fax:607-739-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008031-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy