Provider Demographics
NPI:1669114203
Name:CAMP PEDIATRIC THERAPIES
Entity type:Organization
Organization Name:CAMP PEDIATRIC THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO,COO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-481-2080
Mailing Address - Street 1:9360 SANTA ANITA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6151
Mailing Address - Country:US
Mailing Address - Phone:909-481-2080
Mailing Address - Fax:909-277-7882
Practice Address - Street 1:12402 INDUSTRIAL BLVD STE D6
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5872
Practice Address - Country:US
Practice Address - Phone:442-267-4460
Practice Address - Fax:909-277-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty