Basic Information
| Provider Information | |||||||||
| NPI: | 1376514539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC THERAPY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 SAINT ANDREWS CT | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560018659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073885437 | ||||||||
| FaxNumber: | 5073882108 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 SAINT ANDREWS CT | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560018659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073885437 | ||||||||
| FaxNumber: | 5073882108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | DOBSON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5073885437 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
ID Information
| ID | Type | State | Issuer | Description | 123219 | 01 | MN | UCARE OF MN | OTHER | 78430 | 01 | MN | HEALTH PARTNERS, MN | OTHER | 211329500 | 05 | MN | MEDICAID | 8B515PE | 01 | MN | BCBS OF MN PT CLINIC # | OTHER | 8G323PE | 01 | MN | BCBS OT CLINIC # | OTHER | 8G374PE | 01 | MN | BCBS SPEECH # | OTHER | PREFERRED ONE | 01 | MN | PREFERRED ONE | OTHER |