Provider Demographics
NPI:1730389248
Name:PEDIATRIC THERAPY WORKS, INC.
Entity type:Organization
Organization Name:PEDIATRIC THERAPY WORKS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:727-724-5437
Mailing Address - Street 1:2753 SR 580 STE 111
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3352
Mailing Address - Country:US
Mailing Address - Phone:727-724-5437
Mailing Address - Fax:813-435-2125
Practice Address - Street 1:2753 SR 580 STE 111
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3352
Practice Address - Country:US
Practice Address - Phone:727-724-5437
Practice Address - Fax:813-435-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9659320900000X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891770100Medicaid