Provider Demographics
NPI:1417165259
Name:SAVANNAH CHILDREN'S THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:SAVANNAH CHILDREN'S THERAPY CENTER, LLC
Other - Org Name:CHILDREN'S THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRUIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:912-927-5096
Mailing Address - Street 1:11550 ABERCORN ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1902
Mailing Address - Country:US
Mailing Address - Phone:912-927-5096
Mailing Address - Fax:912-927-5097
Practice Address - Street 1:11550 ABERCORN ST
Practice Address - Street 2:SUITE 15
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1902
Practice Address - Country:US
Practice Address - Phone:912-927-5096
Practice Address - Fax:912-927-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006834225100000X
GAOT001992225X00000X
GASLP006630235Z00000X
GASLP005804235Z00000X
GASLP006487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty