1407834021 NPI number — PEDIATRIC THERAPY SERVICES INC

Table of content: (NPI 1407834021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407834021 NPI number — PEDIATRIC THERAPY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC THERAPY SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407834021
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 E ORANGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33801-5762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-802-3800
Provider Business Mailing Address Fax Number:
863-802-0480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 E ORANGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-802-3800
Provider Business Practice Location Address Fax Number:
863-802-0480
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVA
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, OWNER, OTR
Authorized Official Telephone Number:
863-802-3800

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: PT0002549 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT12452 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA5826 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 024298400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8810363001 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 880357904 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P10705914 . This is a "SIMPLY HEALTHCARE MEDICAID HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 664175 . This is a "AETNA HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y905L . This is a "BCBS OF FL GROUP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 13424302 . This is a "CITRUS HEALTHCARE GRP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6406221 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1407834021 . This is a "CIGNA BAYCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 880357900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y906F . This is a "BCBS FL GROUP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6406221 . This is a "UNITED HEALTHCARE MEDICAID HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 024298400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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