Provider Demographics
NPI:1417924036
Name:NEURO-DEVELOPMENTAL TREATMENT PROGRAMS, INC.
Entity Type:Organization
Organization Name:NEURO-DEVELOPMENTAL TREATMENT PROGRAMS, INC.
Other - Org Name:NDT PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BACK OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-736-1255
Mailing Address - Street 1:817 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3772
Mailing Address - Country:US
Mailing Address - Phone:706-736-1255
Mailing Address - Fax:706-736-1258
Practice Address - Street 1:817 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3772
Practice Address - Country:US
Practice Address - Phone:706-736-1255
Practice Address - Fax:706-736-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300024827DMedicaid
SCGP1346Medicaid