1639733959 NPI number — POP PEDIATRIC THERAPY SERVICES, LLC

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 1639733959 NPI number — POP PEDIATRIC THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POP PEDIATRIC THERAPY SERVICES, LLC
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:
1639733959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POP PEDIATRIC THERAPY
Provider Second Line Business Mailing Address:
7421 MADISON AVE.
Provider Business Mailing Address City Name:
FOREST PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-351-5429
Provider Business Mailing Address Fax Number:
855-529-1595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
POP PEDIATRIC THERAPY
Provider Second Line Business Practice Location Address:
7421 MADISON AVE.
Provider Business Practice Location Address City Name:
FOREST PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-351-5429
Provider Business Practice Location Address Fax Number:
855-529-1595
Provider Enumeration Date:
04/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LEMON
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
708-351-5429

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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