Provider Demographics
NPI:1114713237
Name:VIRTUAL PEDIATRIC THERAPY
Entity type:Organization
Organization Name:VIRTUAL PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NITI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-482-0900
Mailing Address - Street 1:8735 DUNWOODY PL STE 6246
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2995
Mailing Address - Country:US
Mailing Address - Phone:404-482-0900
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL STE 6246
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:404-482-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist