1376514539 NPI number — PEDIATRIC THERAPY SERVICES INC

Table of content: KRISTY WASHINGTON CRNP, PMHNP (NPI 1649235623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376514539 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:
1376514539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SAINT ANDREWS CT
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001-8659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-388-5437
Provider Business Mailing Address Fax Number:
507-388-2108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 SAINT ANDREWS CT
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001-8659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-388-5437
Provider Business Practice Location Address Fax Number:
507-388-2108
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOBSON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-388-5437

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 123219 . This is a "UCARE OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 78430 . This is a "HEALTH PARTNERS, MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 211329500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8B515PE . This is a "BCBS OF MN PT CLINIC #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G323PE . This is a "BCBS OT CLINIC #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8G374PE . This is a "BCBS SPEECH #" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: PREFERRED ONE . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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