Provider Demographics
NPI:1770917106
Name:BMS PEDIATRIC THERAPY GROUP, P.C.
Entity type:Organization
Organization Name:BMS PEDIATRIC THERAPY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:773-724-1537
Mailing Address - Street 1:10719 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3825
Mailing Address - Country:US
Mailing Address - Phone:773-724-1537
Mailing Address - Fax:
Practice Address - Street 1:10719 S SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3825
Practice Address - Country:US
Practice Address - Phone:773-724-1537
Practice Address - Fax:773-264-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty