1346469004 NPI number — REACH PEDIATRICS THERAPY SERVICES PC

Table of content: (NPI 1346469004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346469004 NPI number — REACH PEDIATRICS THERAPY SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REACH PEDIATRICS THERAPY SERVICES PC
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:
ROBIN IRWIN PHYSICAL THERAPY SERVICES P.C.
Provider Other Organization Name Type Code:
4
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:
1346469004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1931 CENTRAL PKWY SW
Provider Second Line Business Mailing Address:
SUITE S
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-309-0454
Provider Business Mailing Address Fax Number:
256-309-0422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1931 CENTRAL PKWY SW
Provider Second Line Business Practice Location Address:
SUITE S
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-309-0454
Provider Business Practice Location Address Fax Number:
256-309-0422
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MODI
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
256-289-0882

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PTH1007 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 529501390 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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