Organization
PENINSULA PEDIATRIC THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANI LAZELL DEAN MS, CCC-SLP (PRESIDENT)
(907) 250-1151
Entity
Organization
Contact information
Practice address
7335 PALMER WASILLA HWY, PALMER, AK 99645-6007
(907) 250-1151
(907) 782-4202
Mailing address
9040 E GOLD PAN DR, PALMER, AK 99645-9684
(907) 250-1151
(907) 782-4202
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
334
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1603051
—
AK
Enumeration date
10/08/2013
Last updated
05/14/2015
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