1104426352 NPI number — PEDIATRIC THERAPY PARTNERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104426352 NPI number — PEDIATRIC THERAPY PARTNERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC THERAPY PARTNERS, 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:
EARLY INTERVENTION PARTNERS
Provider Other Organization Name Type Code:
3
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:
1104426352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3060 FRONTIER WAY S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58104-8909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-364-3945
Provider Business Mailing Address Fax Number:
701-364-3946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3060 FRONTIER WAY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58104-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-364-3945
Provider Business Practice Location Address Fax Number:
701-364-3946
Provider Enumeration Date:
10/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
RODENBERG-ROBERTS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
PATRICIA
Authorized Official Title or Position:
VP & SR. ASST GENERAL COUNSEL
Authorized Official Telephone Number:
952-836-2234

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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