Provider Demographics
NPI:1619255460
Name:BLUEBIRD PEDIATRIC THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:BLUEBIRD PEDIATRIC THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC OT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR/L
Authorized Official - Phone:251-753-1613
Mailing Address - Street 1:6312 PICCADILLY SQUARE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5143
Mailing Address - Country:US
Mailing Address - Phone:251-287-0378
Mailing Address - Fax:251-287-0466
Practice Address - Street 1:6312 PICCADILLY SQUARE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5143
Practice Address - Country:US
Practice Address - Phone:251-287-0378
Practice Address - Fax:251-287-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3077261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL130837Medicaid