Provider Demographics
NPI:1639484314
Name:THERAPY FOR DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:THERAPY FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-6309
Mailing Address - Street 1:4542 E INVERNESS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4619
Mailing Address - Country:US
Mailing Address - Phone:480-926-6309
Mailing Address - Fax:480-926-1365
Practice Address - Street 1:4542 E INVERNESS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4619
Practice Address - Country:US
Practice Address - Phone:480-926-6309
Practice Address - Fax:480-926-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty