Provider Demographics
NPI:1992133037
Name:PEDIATRIC THERAPY STUDIO
Entity type:Organization
Organization Name:PEDIATRIC THERAPY STUDIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-638-3056
Mailing Address - Street 1:8221 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3839
Mailing Address - Country:US
Mailing Address - Phone:703-663-4808
Mailing Address - Fax:844-764-4499
Practice Address - Street 1:8227 OLD - COURTHOUSE RD #115
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-663-4808
Practice Address - Fax:703-665-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 225X00000X, 235Z00000X
VA2202006160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568778587Medicaid