Provider Demographics
NPI:1659832293
Name:GROW PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:GROW PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH PATHOLOGIST
Authorized Official - Phone:256-591-6132
Mailing Address - Street 1:146 WINDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-8691
Mailing Address - Country:US
Mailing Address - Phone:256-591-6132
Mailing Address - Fax:
Practice Address - Street 1:3331 HENRY RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6343
Practice Address - Country:US
Practice Address - Phone:256-624-6377
Practice Address - Fax:256-624-6376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty