1740495191 NPI number — ASPIRE PEDIATRIC THERAPY, LLC

Table of content: (NPI 1740495191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740495191 NPI number — ASPIRE PEDIATRIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRE PEDIATRIC THERAPY, 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:
1740495191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
993 BRODHEAD ROAD
Provider Second Line Business Mailing Address:
STE 10
Provider Business Mailing Address City Name:
CORAOPOLIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15108-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-474-3566
Provider Business Mailing Address Fax Number:
412-474-3575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
993 BRODHEAD ROAD
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
CORAOPOLIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-474-3566
Provider Business Practice Location Address Fax Number:
412-474-3575
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
AMY
Authorized Official Middle Name:
MICHELE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
412-474-3566

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OC005312L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SL006468 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1553259 . This is a "GATEWAY GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7257673 . This is a "AETNA OT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001852889 . This is a "SLP HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001852888 . This is a "HIGHMARK OT GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1016605640003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1016605640002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1016605640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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