Provider Demographics
NPI:1629148200
Name:ADVANCED PEDIATRIC THERAPIES, LLC
Entity Type:Organization
Organization Name:ADVANCED PEDIATRIC THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BEMUS
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:775-825-4744
Mailing Address - Street 1:1025 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1893
Mailing Address - Country:US
Mailing Address - Phone:775-825-4744
Mailing Address - Fax:775-351-1644
Practice Address - Street 1:895 ROBERTA LN
Practice Address - Street 2:STE. 101A
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6802
Practice Address - Country:US
Practice Address - Phone:775-825-4744
Practice Address - Fax:775-351-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP 672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506123Medicaid
NV668131OtherBCBS