Organization
INNOVATIVE PEDIATRIC THERAPIES PT OT SLP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISE PETRICONE PT, PCS (PRESIDENT)
(845) 353-3331
Entity
Organization
Contact information
Practice address
31 BURD ST, NYACK, NY 10960-3205
(845) 353-3331
Mailing address
31 BURD STREET, NYACK, NY 10960
(845) 353-3331
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
003760-1
NY
261QP2000X
Physical Therapy Clinic/Center
Primary
009027-1
NY
261QR0400X
Rehabilitation Clinic/Center
005413-1
NY
Other
Enumeration date
06/20/2011
Last updated
09/23/2011
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