Provider Demographics
NPI:1609828375
Name:PEDIATRIC THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:JANOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-523-5334
Mailing Address - Street 1:5431 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2823
Mailing Address - Country:US
Mailing Address - Phone:816-523-5334
Mailing Address - Fax:816-523-5335
Practice Address - Street 1:5431 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2823
Practice Address - Country:US
Practice Address - Phone:816-523-5334
Practice Address - Fax:816-523-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT120000Medicare UPIN
KST120000AMedicare ID - Type Unspecified