Provider Demographics
NPI:1568109064
Name:ODYSSEY PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:ODYSSEY PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-467-7018
Mailing Address - Street 1:13931 SIERRA STAR CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2976
Mailing Address - Country:US
Mailing Address - Phone:719-283-1406
Mailing Address - Fax:719-249-5834
Practice Address - Street 1:1635 W COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4028
Practice Address - Country:US
Practice Address - Phone:719-283-1406
Practice Address - Fax:719-249-5834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODYSSEY PEDIATRIC THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-16
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty