# PENINSULA PEDIATRIC THERAPY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194152058
- **Authorized official:** MS. SHANI LAZELL DEAN MS, CCC-SLP (PRESIDENT)
- **Authorized official phone:** (907) 250-1151

## Contact information

- **Practice address:** 7335 PALMER WASILLA HWY, PALMER, AK 99645-6007
- **Practice address phone:** (907) 250-1151
- **Practice address fax:** (907) 782-4202
- **Mailing address:** 9040 E GOLD PAN DR, PALMER, AK 99645-9684
- **Mailing address phone:** (907) 250-1151
- **Mailing address fax:** (907) 782-4202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 334 | AK | Yes |

## Other

- **Enumeration date:** 10/08/2013
- **Last updated:** 05/14/2015