Provider Demographics
NPI:1255390928
Name:PEDIATRIC THERAPY INTERVENTIONS, INC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY INTERVENTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-951-7013
Mailing Address - Street 1:2065 MCDADE RD
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4721
Mailing Address - Country:US
Mailing Address - Phone:706-951-7013
Mailing Address - Fax:706-592-6872
Practice Address - Street 1:2065 MCDADE RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4721
Practice Address - Country:US
Practice Address - Phone:706-951-7013
Practice Address - Fax:706-592-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty