Provider Demographics
NPI:1528658432
Name:PEDIATRIC THERAPY SPECIALTIES
Entity type:Organization
Organization Name:PEDIATRIC THERAPY SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-351-1490
Mailing Address - Street 1:675 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3602
Mailing Address - Country:US
Mailing Address - Phone:812-351-1490
Mailing Address - Fax:812-301-1329
Practice Address - Street 1:675 3RD AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3602
Practice Address - Country:US
Practice Address - Phone:812-351-1490
Practice Address - Fax:812-301-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1295496503Medicaid
IN1942812987Medicaid
IN1750911129Medicaid
IN1851029318Medicaid
IN1073131710Medicaid
IN1164814307Medicaid
IN1689708497Medicaid
IN1790291391Medicaid
IN1023500915Medicaid
IN1063509032Medicaid
IN1386945764Medicaid
IN1528658432Medicaid
IN1720411739Medicaid