Provider Demographics
NPI:1427422179
Name:ALLY PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:ALLY PEDIATRIC THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-606-2237
Mailing Address - Street 1:10595 N TATUM BLVD STE E146
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1072
Mailing Address - Country:US
Mailing Address - Phone:602-606-2237
Mailing Address - Fax:844-475-2307
Practice Address - Street 1:10595 N TATUM BLVD STE E146
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253
Practice Address - Country:US
Practice Address - Phone:602-606-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-114103K00000X
AZ9461235Z00000X
AZSLP9461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty