Provider Demographics
NPI:1134581788
Name:PEDIATRIC THERAPY ASSOCIATES OF NE, PA INC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY ASSOCIATES OF NE, PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR, SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MCHALE
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:570-228-6838
Mailing Address - Street 1:117 SYMPHONY TER
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-3601
Mailing Address - Country:US
Mailing Address - Phone:570-228-6838
Mailing Address - Fax:
Practice Address - Street 1:117 SYMPHONY TER
Practice Address - Street 2:
Practice Address - City:SHOHOLA
Practice Address - State:PA
Practice Address - Zip Code:18458-3601
Practice Address - Country:US
Practice Address - Phone:570-228-6838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty