Organization
SMART PEDIATRIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN T. GREGG OTR/L (FOUNDER/OWNER)
(623) 399-6159
Entity
Organization
Contact information
Practice address
13851 W LA MAR BLVD, SUITE D, GOODYEAR, AZ 85338-1389
(623) 399-6159
(623) 399-6416
Mailing address
13851 W LA MAR BLVD, SUITE D, GOODYEAR, AZ 85338-1389
(623) 399-6159
(623) 399-6416
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073861852
INDIVIDUAL NPI
AZ
Enumeration date
02/15/2013
Last updated
03/28/2013
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