Provider Demographics
NPI:1760178776
Name:GROW PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:GROW PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-431-9623
Mailing Address - Street 1:488 E 11TH AVE STE LL2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3601
Mailing Address - Country:US
Mailing Address - Phone:541-359-1009
Mailing Address - Fax:541-359-1039
Practice Address - Street 1:488 E 11TH AVE STE LL2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3601
Practice Address - Country:US
Practice Address - Phone:541-505-8180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty