Provider Demographics
NPI:1922513498
Name:PEDIATRIC THERAPY 4 KIDS
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY 4 KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-503-5817
Mailing Address - Street 1:8635 CHICOT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4445
Mailing Address - Country:US
Mailing Address - Phone:501-503-5817
Mailing Address - Fax:
Practice Address - Street 1:8635 CHICOT RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4445
Practice Address - Country:US
Practice Address - Phone:501-503-5817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center