Provider Demographics
NPI:1396050910
Name:BACKYARD TREEHOUSE PEDIATRIC THERAPY CENTER PC
Entity type:Organization
Organization Name:BACKYARD TREEHOUSE PEDIATRIC THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:610-751-4158
Mailing Address - Street 1:39 PALOMINO CIR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-9517
Mailing Address - Country:US
Mailing Address - Phone:610-751-4158
Mailing Address - Fax:610-588-0164
Practice Address - Street 1:25 S. BROAD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2167
Practice Address - Country:US
Practice Address - Phone:610-751-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty