Provider Demographics
NPI:1861666307
Name:PEDIATRIC THERAPIES, INC
Entity type:Organization
Organization Name:PEDIATRIC THERAPIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASIE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:615-377-1623
Mailing Address - Street 1:1880 GENERAL GEORGE PATTON DR # B
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6409
Mailing Address - Country:US
Mailing Address - Phone:615-377-1623
Mailing Address - Fax:
Practice Address - Street 1:1880 B GENERAL GEORGE PATTON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6409
Practice Address - Country:US
Practice Address - Phone:615-377-1623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
4106076OtherBCBS PAR #