Provider Demographics
NPI:1154795755
Name:CHILD INSPIRED THERAPIES
Entity type:Organization
Organization Name:CHILD INSPIRED THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENDALYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-301-0762
Mailing Address - Street 1:1540 E RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6506
Mailing Address - Country:US
Mailing Address - Phone:928-301-0762
Mailing Address - Fax:
Practice Address - Street 1:1540 E RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6506
Practice Address - Country:US
Practice Address - Phone:928-301-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty