Provider Demographics
NPI:1396915427
Name:PEDIATRIC THERAPY CENTER
Entity type:Organization
Organization Name:PEDIATRIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MULLENDORE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:402-932-2782
Mailing Address - Street 1:10601 S 72ND ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3407
Mailing Address - Country:US
Mailing Address - Phone:402-932-2782
Mailing Address - Fax:
Practice Address - Street 1:10601 S 72ND ST
Practice Address - Street 2:STE. 103
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3407
Practice Address - Country:US
Practice Address - Phone:402-932-2782
Practice Address - Fax:402-932-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty