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Organization

CHILDHOOD EARLY INTERVENTION, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. AUDREY LINN LIST PHYSICAL THERAPIST (CHIEF EXECUTIVE OFFICER)
(717) 360-3989
Entity
Organization

Contact information

Practice address
6743 FAIRWAY DR E, FAYETTEVILLE, PA 17222-9400
(717) 360-3989
(717) 352-8360
Mailing address
6743 FAIRWAY DR E, FAYETTEVILLE, PA 17222-9400
(717) 360-3989
(717) 352-8360

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2251P0200X
Pediatric Physical Therapist
225X00000X
Occupational Therapist
Primary
225XP0200X
Pediatric Occupational Therapist
235Z00000X
Speech-Language Pathologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1016437230001
PA
Enumeration date
12/20/2006
Last updated
09/11/2025
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