Provider Demographics
NPI:1689282568
Name:PALS PEDIATRIC THERAPY, PLLC
Entity Type:Organization
Organization Name:PALS PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIPALI
Authorized Official - Middle Name:PATEL
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:601-310-8393
Mailing Address - Street 1:121 WALKING TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-4819
Mailing Address - Country:US
Mailing Address - Phone:601-310-8393
Mailing Address - Fax:
Practice Address - Street 1:4262 POPPS FERRY RD STE B
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2391
Practice Address - Country:US
Practice Address - Phone:301-200-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty