Provider Demographics
NPI:1518588748
Name:TWO RIVER PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:TWO RIVER PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED, CCC-SLP
Authorized Official - Phone:732-899-8199
Mailing Address - Street 1:33 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2004
Mailing Address - Country:US
Mailing Address - Phone:732-889-8199
Mailing Address - Fax:
Practice Address - Street 1:33 HARDING RD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2004
Practice Address - Country:US
Practice Address - Phone:732-889-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty