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Contact Information

ABC PEDIATRIC THERAPY, LLC
634 N MAIN ST
SUITE 3
O'FALLON, IL62269-3746
 Phone: 618-632-4222
 Fax: 618-632-4658
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Speech-Language Pathologist

235Z00000X 15 Speech Language Pathologist
 

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for ABC PEDIATRIC THERAPY, LLC

NPI Number 1124044698
LBN Legal business name ABC PEDIATRIC THERAPY, LLC
Authorized official AMY BRUCE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/15/2006
Last updated 06/17/2011 - About 15 years ago
Identifiers
IL Medicaid 348620164001
IL Other 08232136 BLUE CROSS BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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