Provider Demographics
NPI:1154080117
Name:HAPPY FEET PEDIATRIC THERAPY
Entity type:Organization
Organization Name:HAPPY FEET PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:570-801-5828
Mailing Address - Street 1:941 MITMAN RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8236
Mailing Address - Country:US
Mailing Address - Phone:215-570-5828
Mailing Address - Fax:
Practice Address - Street 1:941 MITMAN RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8236
Practice Address - Country:US
Practice Address - Phone:215-570-5828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty