Provider Demographics
NPI:1063869808
Name:PEDIATRIC THERAPY INTENSIVES LLC
Entity type:Organization
Organization Name:PEDIATRIC THERAPY INTENSIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-571-7309
Mailing Address - Street 1:2338 IMMOKALEE RD # 187
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1445
Mailing Address - Country:US
Mailing Address - Phone:239-571-7309
Mailing Address - Fax:866-506-9679
Practice Address - Street 1:9330 SUMMER PL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-1517
Practice Address - Country:US
Practice Address - Phone:239-571-7309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty