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Organization

PEDIATRIC THERAPY, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ALICIA CLARK OT (PRESIDENT)
(866) 832-1708
Entity
Organization

Contact information

Practice address
3605 NE LOOP 286 STE 1800, PARIS, TX 75460-5086
(866) 832-1708
(888) 789-4391
Mailing address
1620 SILVER LN, AUBREY, TX 76227-1623
(866) 832-1708
(888) 789-4391

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
2251P0200X
Pediatric Physical Therapist
Primary
225XP0200X
Pediatric Occupational Therapist
235Z00000X
Speech-Language Pathologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0189HM
BLUECROSS BLUESHIELD ID
TX
01
125383100
FIRSTCARE ID
TX
Enumeration date
12/13/2006
Last updated
06/22/2023
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