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Organization
PROACTIVE PEDIATRIC THERAPY, LLC
Active
Organization
PROACTIVE PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA DOLPHIN OT (MANAGER)
(319) 721-9333
Entity
Organization
Contact information
Practice address
1717 BOYSON RD, HIAWATHA, IA 52233-2313
(319) 721-9333
Mailing address
1717 BOYSON RD, HIAWATHA, IA 52233-2313
(319) 721-9333
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
NULL
174N00000X
Lactation Consultant (Non-RN)
—
—
2251P0200X
Pediatric Physical Therapist
—
NULL
2251P0200X
Pediatric Physical Therapist
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
NULL
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
NULL
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
08/29/2019
Last updated
02/26/2020
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