Provider Demographics
NPI:1982624771
Name:PEDIATRIC POTENTIALS, INC.
Entity Type:Organization
Organization Name:PEDIATRIC POTENTIALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-322-3962
Mailing Address - Street 1:295 WAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6744
Mailing Address - Country:US
Mailing Address - Phone:407-322-3962
Mailing Address - Fax:407-323-1614
Practice Address - Street 1:295 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6744
Practice Address - Country:US
Practice Address - Phone:407-322-3962
Practice Address - Fax:407-323-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888328900Medicaid