Provider Demographics
NPI:1518361120
Name:PENDLEY BUSINESS VENTURES, INC.
Entity Type:Organization
Organization Name:PENDLEY BUSINESS VENTURES, INC.
Other - Org Name:LEAP PEDIATRIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:678-888-1590
Mailing Address - Street 1:PO BOX 2802
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-6510
Mailing Address - Country:US
Mailing Address - Phone:678-888-1590
Mailing Address - Fax:678-731-1590
Practice Address - Street 1:6470 GA HIGHWAY 400
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-3460
Practice Address - Country:US
Practice Address - Phone:678-888-1590
Practice Address - Fax:678-731-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-11
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0096272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108614CMedicaid