Provider Demographics
NPI:1760500508
Name:PROFESSIONAL EVALUATION AND DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL EVALUATION AND DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-327-0045
Mailing Address - Street 1:PO BOX 9131
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40209-0131
Mailing Address - Country:US
Mailing Address - Phone:502-327-0045
Mailing Address - Fax:502-327-0019
Practice Address - Street 1:918 ORMSBY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-4536
Practice Address - Country:US
Practice Address - Phone:502-327-0045
Practice Address - Fax:502-327-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-001051225100000X
KYKY-R2746225X00000X
KY3098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty