Provider Demographics
NPI:1841506086
Name:LITTLE WONDERS CHILD GROWTH & DEVELOPMENT CENTER
Entity type:Organization
Organization Name:LITTLE WONDERS CHILD GROWTH & DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JON
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:610-275-5437
Mailing Address - Street 1:100 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1330
Mailing Address - Country:US
Mailing Address - Phone:610-275-5437
Mailing Address - Fax:610-275-5477
Practice Address - Street 1:100 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1330
Practice Address - Country:US
Practice Address - Phone:610-275-5437
Practice Address - Fax:610-275-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO11289L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency