Provider Demographics
NPI:1386393387
Name:PEDIATRIC PHYSICIAN SERVICES, INC.
Entity type:Organization
Organization Name:PEDIATRIC PHYSICIAN SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:SCHULHOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-898-7451
Mailing Address - Street 1:601 5TH ST S DEPT 6941
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-4429
Mailing Address - Fax:727-767-4970
Practice Address - Street 1:3440 W MLK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6223
Practice Address - Country:US
Practice Address - Phone:813-910-5140
Practice Address - Fax:813-350-0132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:59-0683252
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-18
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No2278P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedNeonatal/PediatricsGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty