Provider Demographics
NPI: | 1538469564 |
---|---|
Name: | THERAPEUTIC BRANCHES, P.C. |
Entity Type: | Organization |
Organization Name: | THERAPEUTIC BRANCHES, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JULIE |
Authorized Official - Middle Name: | ANNE |
Authorized Official - Last Name: | BERG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, CCC-SLP |
Authorized Official - Phone: | 219-742-5951 |
Mailing Address - Street 1: | 12845 PARRISH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CEDAR LAKE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46303-9298 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 219-742-5951 |
Mailing Address - Fax: | 219-374-5624 |
Practice Address - Street 1: | 10915 W 133RD AVE |
Practice Address - Street 2: | |
Practice Address - City: | CEDAR LAKE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46303-9706 |
Practice Address - Country: | US |
Practice Address - Phone: | 219-742-5951 |
Practice Address - Fax: | 219-374-5624 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-10-25 |
Last Update Date: | 2010-10-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |