Provider Demographics
NPI:1285469957
Name:ON TRACK PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:ON TRACK PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-252-4464
Mailing Address - Street 1:10064 KEUSS FARMS DR
Mailing Address - Street 2:
Mailing Address - City:RICHWOODS
Mailing Address - State:MO
Mailing Address - Zip Code:63071-2379
Mailing Address - Country:US
Mailing Address - Phone:636-252-4464
Mailing Address - Fax:636-442-1455
Practice Address - Street 1:54 THE LEGENDS PKWY STE 157
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:636-252-4464
Practice Address - Fax:636-442-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies