Provider Demographics
NPI:1942893631
Name:PEDIATRIC THERAPY SOURCE
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:412-498-7369
Mailing Address - Street 1:111 CRESCENT HILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-3701
Mailing Address - Country:US
Mailing Address - Phone:412-498-7369
Mailing Address - Fax:
Practice Address - Street 1:800 BURSCA DR STE 804
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1451
Practice Address - Country:US
Practice Address - Phone:412-408-6177
Practice Address - Fax:412-604-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty