Organization
PEDIATRIC THERAPY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANA RIVA OT (PRESIDENT, OWNER, OTR)
(863) 802-3800
Entity
Organization
Contact information
Practice address
1215 E ORANGE ST, LAKELAND, FL 33801
(863) 802-3800
(863) 802-0480
Mailing address
1215 E ORANGE STREET, LAKELAND, FL 33801-5762
(863) 802-3800
(863) 802-0480
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
2251P0200X
Pediatric Physical Therapist
PT0002549
FL
225XP0200X
Pediatric Occupational Therapist
OT12452
FL
235Z00000X
Speech-Language Pathologist
SA5826
FL
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024298400
—
FL
01
—
13424302
CITRUS HEALTHCARE GRP ID
FL
01
—
1407834021
CIGNA BAYCARE
FL
01
—
6406221
UNITED HEALTHCARE
FL
01
—
664175
AETNA HEALTHCARE
FL
05
—
880357900
—
FL
05
—
880357904
—
FL
01
—
8810363001
CIGNA HEALTHCARE
FL
01
—
P10705914
SIMPLY HEALTHCARE MEDICAID HMO
FL
01
—
Y905L
BCBS OF FL GROUP ID
FL
01
—
Y906F
BCBS FL GROUP ID
FL
Enumeration date
01/04/2006
Last updated
08/20/2018
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