Provider Demographics
NPI:1699108530
Name:ADVENTURE TIME PEDIATRIC THERAPY & LEARNING CENTER, LLC
Entity type:Organization
Organization Name:ADVENTURE TIME PEDIATRIC THERAPY & LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:724-458-1500
Mailing Address - Street 1:120 S BROAD ST STE A
Mailing Address - Street 2:P.O. BOX 51
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1544
Mailing Address - Country:US
Mailing Address - Phone:724-458-1500
Mailing Address - Fax:724-458-1501
Practice Address - Street 1:120 S BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1544
Practice Address - Country:US
Practice Address - Phone:724-458-1500
Practice Address - Fax:724-458-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006149L2251P0200X
PAOC006950L225XP0200X
PASL005839L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty