Organization
EMPIRICAL PEDIATRIC THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAISEN STANGO JD, MBA (VICE PRESIDENT)
(267) 908-7772
Entity
Organization
Contact information
Practice address
413 FAIRMOUNT AVE # 1, PHILADELPHIA, PA 19123-2807
(267) 908-7772
Mailing address
702 N 3RD ST PMB 854, PHILADELPHIA, PA 19123
(267) 908-7772
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
BH002146
PA
225X00000X
Occupational Therapist
Primary
OC010741
PA
Other
Enumeration date
11/08/2017
Last updated
11/08/2017
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