Organization
THERAKIDS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE A HARTRICH (SECRETARY)
(618) 444-9699
Entity
Organization
Contact information
Practice address
10354 PRAIRIE DELL RD, SHIPMAN, IL 62685-6105
(618) 836-7442
Mailing address
10354 PRAIRIE DELL RD, SHIPMAN, IL 62685-6105
(618) 836-7442
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
02/21/2012
Last updated
02/21/2012
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