Organization
GRACENT PEDIATRIC THERAPIES - INDIANA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MCKELLAR (CFO)
(865) 567-0756
Entity
Organization
Contact information
Practice address
5525 ABBE WOOD DR, NEWBURGH, IN 47630-0040
(812) 483-9980
Mailing address
950 LEE ST STE 105, DES PLAINES, IL 60016-6556
(865) 567-0756
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
08/28/2024
Last updated
10/02/2024
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