Provider Demographics
NPI:1588977953
Name:PEDIATRIC THERAPY PROFESSIONALS, INC.
Entity type:Organization
Organization Name:PEDIATRIC THERAPY PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:541-368-4313
Mailing Address - Street 1:111 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9535
Mailing Address - Country:US
Mailing Address - Phone:541-368-4313
Mailing Address - Fax:541-929-4967
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9535
Practice Address - Country:US
Practice Address - Phone:541-368-4313
Practice Address - Fax:541-929-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty