Provider Demographics
NPI:1508065426
Name:PEDI SPOT LLC
Entity Type:Organization
Organization Name:PEDI SPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-596-7700
Mailing Address - Street 1:4965 PRESTON PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 ROWLETT RD
Practice Address - Street 2:SUITE A
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3700
Practice Address - Country:US
Practice Address - Phone:972-238-9916
Practice Address - Fax:972-664-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation