Provider Demographics
NPI:1770754475
Name:SPECIAL NEEDS PEDIATRIC THERAPY SERVICES
Entity type:Organization
Organization Name:SPECIAL NEEDS PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:678-714-6708
Mailing Address - Street 1:4411 SUWANEE DAM RD
Mailing Address - Street 2:SUITE 455
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8701
Mailing Address - Country:US
Mailing Address - Phone:678-714-6708
Mailing Address - Fax:770-456-5224
Practice Address - Street 1:4411 SUWANEE DAM RD
Practice Address - Street 2:SUITE 455
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8701
Practice Address - Country:US
Practice Address - Phone:678-714-6708
Practice Address - Fax:770-456-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0015652251P0200X
GA003562225XP0200X
GA001582225XP0200X
GA002798225XP0200X
GA004017225XP0200X
GA0043012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty