Provider Demographics
NPI:1699976233
Name:MAIN LINE PEDIATRIC THERAPY CENTER, INC.
Entity type:Organization
Organization Name:MAIN LINE PEDIATRIC THERAPY CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABBE
Authorized Official - Middle Name:BERNSTEIN
Authorized Official - Last Name:AVART
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:610-527-7714
Mailing Address - Street 1:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-0139
Mailing Address - Country:US
Mailing Address - Phone:610-527-7714
Mailing Address - Fax:610-527-7716
Practice Address - Street 1:840 ROSCOMMON RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1845
Practice Address - Country:US
Practice Address - Phone:610-527-7715
Practice Address - Fax:610-527-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003148L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency