Provider Demographics
NPI:1699178566
Name:ABC PEDIATRIC THERAPY PARTNERS, INC.
Entity Type:Organization
Organization Name:ABC PEDIATRIC THERAPY PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:BILBAO
Authorized Official - Last Name:CANUP
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA
Authorized Official - Phone:706-372-4349
Mailing Address - Street 1:1175 OGLETHORPE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2129
Mailing Address - Country:US
Mailing Address - Phone:706-372-4349
Mailing Address - Fax:404-393-3862
Practice Address - Street 1:1175 OGLETHORPE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2129
Practice Address - Country:US
Practice Address - Phone:706-372-4349
Practice Address - Fax:404-393-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000931873CMedicaid