Provider Demographics
NPI:1386450245
Name:SOAR PEDIATRIC DEVELOPMENTAL THERAPY, LLC
Entity type:Organization
Organization Name:SOAR PEDIATRIC DEVELOPMENTAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST, FOUNDE
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:814-227-3385
Mailing Address - Street 1:100 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:PETROLIA
Mailing Address - State:PA
Mailing Address - Zip Code:16050-9622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:PETROLIA
Practice Address - State:PA
Practice Address - Zip Code:16050-9622
Practice Address - Country:US
Practice Address - Phone:814-227-3385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty