Provider Demographics
NPI:1770798126
Name:THE CENTER FOR PEDIATRIC THERAPY INC
Entity type:Organization
Organization Name:THE CENTER FOR PEDIATRIC THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-670-8600
Mailing Address - Street 1:9 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1851
Mailing Address - Country:US
Mailing Address - Phone:610-670-8600
Mailing Address - Fax:
Practice Address - Street 1:9 BRISTOL CT
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1851
Practice Address - Country:US
Practice Address - Phone:610-670-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CENTER FOR PEDIATRIC THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008394235Z00000X
PASL001515L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1914048OtherHIGHMARK BLUE SHIELD