Provider Demographics
NPI:1104684497
Name:THE ARK PEDIATRIC THERAPY SERVICES
Entity type:Organization
Organization Name:THE ARK PEDIATRIC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-345-6365
Mailing Address - Street 1:207 COMMERCE CIR SW STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-6860
Mailing Address - Country:US
Mailing Address - Phone:256-345-6365
Mailing Address - Fax:
Practice Address - Street 1:207 COMMERCE CIR SW STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6860
Practice Address - Country:US
Practice Address - Phone:256-580-5045
Practice Address - Fax:256-274-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty