Provider Demographics
NPI:1578505244
Name:PEDIATRIC THERAPY PARTNERS INC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY PARTNERS INC
Other - Org Name:PTP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-306-3641
Mailing Address - Street 1:1814 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2929
Mailing Address - Country:US
Mailing Address - Phone:706-306-3641
Mailing Address - Fax:818-861-7348
Practice Address - Street 1:887 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4713
Practice Address - Country:US
Practice Address - Phone:626-289-8979
Practice Address - Fax:818-861-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABM991AMedicare PIN
GAGRP7069Medicare PIN
GAGRP7069Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER