Provider Demographics
NPI:1306132964
Name:PEDIATRIC THERAPY GROUP
Entity type:Organization
Organization Name:PEDIATRIC THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF OT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KESTER
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:941-447-4707
Mailing Address - Street 1:4440B 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-1201
Mailing Address - Country:US
Mailing Address - Phone:941-752-0408
Mailing Address - Fax:
Practice Address - Street 1:4440B 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1201
Practice Address - Country:US
Practice Address - Phone:941-752-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLT13711251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage